Provider Demographics
NPI:1669022257
Name:RODARTE, MADISEN PAIGE (MSW)
Entity Type:Individual
Prefix:
First Name:MADISEN
Middle Name:PAIGE
Last Name:RODARTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 S GARTHWAITE RD
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1155
Mailing Address - Country:US
Mailing Address - Phone:765-677-3094
Mailing Address - Fax:
Practice Address - Street 1:3925 S GARTHWAITE RD
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1155
Practice Address - Country:US
Practice Address - Phone:765-677-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker