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General NPI Number Information
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NPI Number | 1265853667
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Entity Type | Organization
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Legal Business Name | JAMIE RODRIGUEZ LLC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 104 W CUSTER AVE SUITE 1
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City | HELENA
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State | MT
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Zip | 59602-0106
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Country | US
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Telephone | 406-465-9738
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Fax | 406-442-6369
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Provider Business Mailing Address
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Address Line | PO BOX 772
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City | BOULDER
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State | MT
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Zip | 59632-0772
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Country | US
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Telephone | 406-465-9738
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Fax | 406-442-6369
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. JAMIE DANIELLE RODRIGUEZ
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Credential | LCSW
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Telephone | 406-465-9738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 647-LCSW
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License Number State | MT
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