MEDICARE: CYNTHIA SUSAN ROHLFING DODSON LCSW

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	101Y00000X	Counselor	004009	MO
2	101YP2500X	Professional Counselor	004009	MO
3	104100000X	Social Worker	004009	MO
4	1041C0700X	Clinical Social Worker	004009	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427226612	OTHER	MO	OPTUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386284065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA SUSAN ROHLFING DODSON LCSW

Provider Business Mailing Address
First Line	:	1100 TERRACE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1335
Country	:	US
Telephone Number	:	314-440-5783
Fax Number	:	314-781-7914

Provider Business Practice Location Address
First Line	:	2814 SUTTON BLVD
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-3010
Country	:	US
Telephone Number	:	314-440-5783
Fax Number	:	314-781-7914

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	08/03/2020

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