Provider Demographics
NPI:1134297401
Name:RODEWALD, JILL HELENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:HELENE
Last Name:RODEWALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 RAINBOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4645
Mailing Address - Country:US
Mailing Address - Phone:818-889-9508
Mailing Address - Fax:
Practice Address - Street 1:30961 AGOURA RD
Practice Address - Street 2:203
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4618
Practice Address - Country:US
Practice Address - Phone:818-991-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS128201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW12820Medicare ID - Type Unspecified