Provider Demographics
NPI:1043587322
Name:ROHDE, JILL (LMSW, LAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ROHDE
Suffix:
Gender:F
Credentials:LMSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 WEST 31ST. STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3042
Mailing Address - Country:US
Mailing Address - Phone:785-843-9262
Mailing Address - Fax:785-843-9264
Practice Address - Street 1:3015 W 31ST ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3042
Practice Address - Country:US
Practice Address - Phone:785-843-9262
Practice Address - Fax:785-843-9264
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7988104100000X
KS194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)