Provider Demographics
NPI:1568894319
Name:DODGE, VERONICA ROSE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:ROSE
Last Name:DODGE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:ROSE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:38 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1520
Mailing Address - Country:US
Mailing Address - Phone:585-278-4472
Mailing Address - Fax:
Practice Address - Street 1:38 ELM ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1520
Practice Address - Country:US
Practice Address - Phone:585-278-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist