Provider Demographics
NPI:1093273187
Name:RODRIGUEZ, ELLEN MICHAELA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MICHAELA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E MAUMEE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2724
Mailing Address - Country:US
Mailing Address - Phone:517-438-8144
Mailing Address - Fax:517-438-8195
Practice Address - Street 1:136 E MAUMEE ST STE 8
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2724
Practice Address - Country:US
Practice Address - Phone:517-438-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker