Provider Demographics
NPI:1295183903
Name:HODGE, NORMAN (LAC)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2305
Mailing Address - Country:US
Mailing Address - Phone:913-342-0888
Mailing Address - Fax:913-342-2644
Practice Address - Street 1:1125 N 5TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2305
Practice Address - Country:US
Practice Address - Phone:913-342-0888
Practice Address - Fax:913-342-2644
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)