Provider Demographics
NPI:1114957222
Name:HOWARD, RODNEY CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:CHARLES
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 UNIVERSITY PARK DR
Mailing Address - Street 2:STE 110
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-333-8287
Mailing Address - Fax:517-333-8295
Practice Address - Street 1:2121 UNIVERSITY PARK DR
Practice Address - Street 2:STE 110
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-333-8287
Practice Address - Fax:517-333-8295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002824103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION14880Medicare ID - Type Unspecified
MI680C34503Medicare UPIN