Provider Demographics
NPI:1255670931
Name:RODGERS, AMANDA JEAN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 W UNIVERSITY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2970
Mailing Address - Country:US
Mailing Address - Phone:580-924-7330
Mailing Address - Fax:580-924-7334
Practice Address - Street 1:2425 W UNIVERSITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2970
Practice Address - Country:US
Practice Address - Phone:580-924-7330
Practice Address - Fax:580-924-7334
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)