MEDICARE: SUSAN K ROHDEN LISW

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	02616	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43766	OTHER		WELLMARK

General Provider Information

NPI Number	:	1700852670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN K ROHDEN LISW

Provider Business Mailing Address
First Line	:	1601 MILITARY ROAD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51103-1715
Country	:	US
Telephone Number	:	712-252-4547
Fax Number	:	712-252-3785

Provider Business Practice Location Address
First Line	:	1321 2ND AVENUE SOUTH
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4925
Country	:	US
Telephone Number	:	515-576-4156
Fax Number	:	515-576-6998

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN K ROHDEN LISW” Practice Location

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