Provider Demographics
NPI:1578626362
Name:RODNE-COLE, EVY (LP)
Entity Type:Individual
Prefix:
First Name:EVY
Middle Name:
Last Name:RODNE-COLE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 7TH ST
Mailing Address - Street 2:P.O BOX 104
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1220
Mailing Address - Country:US
Mailing Address - Phone:320-585-5760
Mailing Address - Fax:320-585-5760
Practice Address - Street 1:202 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1220
Practice Address - Country:US
Practice Address - Phone:320-585-5760
Practice Address - Fax:320-585-5760
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3343103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist