Provider Demographics
NPI:1033420831
Name:RODRIQUEZ-FLETCHER, LORI R (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:RODRIQUEZ-FLETCHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1680
Mailing Address - Country:US
Mailing Address - Phone:308-632-8547
Mailing Address - Fax:308-632-0135
Practice Address - Street 1:2622 AVENUE C
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1680
Practice Address - Country:US
Practice Address - Phone:308-632-8547
Practice Address - Fax:308-632-0135
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4093101YM0800X
NE14571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health