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NPI Code Detail

MEDICARE: DR. JOHN R RODWICK PH.D.

MEDICARE: DR. JOHN R RODWICK PH.D.
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
1101YM0800XMental Health Counselor82171NM
2103T00000XPsychologist1241CO

General Provider Information

NPI Number : 1528003142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN R RODWICK PH.D.
Provider Business Mailing Address
First Line : 4300 REAL DEL SUR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7205
Country : US
Telephone Number : 505-647-2884
Fax Number :
Provider Business Practice Location Address
First Line : 100 W GRIGGS AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1234
Country : US
Telephone Number : 505-647-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 09/11/2025

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Directions to “ DR. JOHN R RODWICK PH.D.” Practice Location

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