MEDICARE: BETTY RODGERS 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	1041C0700X	Clinical Social Worker	6801090510	MI

General Provider Information

NPI Number	:	1689477648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY RODGERS LCSW

Provider Business Mailing Address
First Line	:	45601 S INTERSTATE 94 SERVICE DR UNIT 101
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48112-4905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45601 S INTERSTATE 94 SERVICE DR UNIT 101
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48112-4905
Country	:	US
Telephone Number	:	734-922-2018
Fax Number	:

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

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	03/28/2025

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