Provider Demographics
NPI:1679587190
Name:BALL, RODNEY L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:L
Last Name:BALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 STATE RD 26 E
Mailing Address - Street 2:STE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4768
Mailing Address - Country:US
Mailing Address - Phone:765-447-4922
Mailing Address - Fax:
Practice Address - Street 1:3530 STATE RD 26 E
Practice Address - Street 2:STE C
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4768
Practice Address - Country:US
Practice Address - Phone:765-447-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000008A1041C0700X
IN35000109A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000187421OtherANTHEM BCBS
222600Medicare ID - Type Unspecified