MEDICARE: IAN MILLER RODEHORST PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	PLC10602	LA

General Provider Information

NPI Number	:	1053112904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN MILLER RODEHORST PLPC

Provider Business Mailing Address
First Line	:	615 CHEVELLE CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6502
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 CHEVELLE CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6502
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	01/12/2026

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