Provider Demographics
NPI:1043841877
Name:RODENBAUGH, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RODENBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 S CO-105
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133
Mailing Address - Country:US
Mailing Address - Phone:720-530-9344
Mailing Address - Fax:
Practice Address - Street 1:443 S CO-105
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133
Practice Address - Country:US
Practice Address - Phone:720-530-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0020890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)