MEDICARE: JAELEEN R RODRIQUEZ

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	104100000X	Social Worker	LSW.0009926375	CO
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1528819521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAELEEN R RODRIQUEZ

Provider Business Mailing Address
First Line	:	7863 IRISH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-9712
Country	:	US
Telephone Number	:	719-491-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	7863 IRISH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-9712
Country	:	US
Telephone Number	:	719-491-1821
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	05/29/2025

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Directions to “ JAELEEN R RODRIQUEZ ” Practice Location

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