Provider Demographics
NPI:1376741496
Name:RODGAARD-MCGINLEY, MICHELE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:RODGAARD-MCGINLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:RODGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741
Mailing Address - Country:US
Mailing Address - Phone:808-332-5015
Mailing Address - Fax:808-332-5015
Practice Address - Street 1:2-2514 KAUMUALII HWY.
Practice Address - Street 2:SUITE 105
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741
Practice Address - Country:US
Practice Address - Phone:808-332-5015
Practice Address - Fax:808-332-5015
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 161851041C0700X
HILCSW 34571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILCSW3457OtherSOCIAL WORKER LICENSE NUMBER
CAGR0051600Medicaid
CAGR0051600Medicaid