Provider Demographics
NPI:1083131726
Name:RODRIGUEZ, KENDRA LEIGH (LSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LEIGH
Other - Last Name:VERMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-0146
Mailing Address - Country:US
Mailing Address - Phone:419-335-6122
Mailing Address - Fax:419-318-4157
Practice Address - Street 1:3478 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2225
Practice Address - Country:US
Practice Address - Phone:419-335-6122
Practice Address - Fax:419-318-4157
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700730104100000X
OHS.17007301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker