Provider Demographics
NPI:1467111955
Name:RODEHEFFER, JAMES ALLEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:RODEHEFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 ALLISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4546
Mailing Address - Country:US
Mailing Address - Phone:317-225-0615
Mailing Address - Fax:
Practice Address - Street 1:8505 WOODFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4309
Practice Address - Country:US
Practice Address - Phone:317-257-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006650A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist