Provider Demographics
NPI:1265853667
Name:JAMIE RODRIGUEZ LLC
Entity Type:Organization
Organization Name:JAMIE RODRIGUEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-465-9738
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0772
Mailing Address - Country:US
Mailing Address - Phone:406-465-9738
Mailing Address - Fax:406-442-6369
Practice Address - Street 1:104 W CUSTER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0106
Practice Address - Country:US
Practice Address - Phone:406-465-9738
Practice Address - Fax:406-442-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT647-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty