Provider Demographics
NPI:1689786188
Name:RODON, CAROLE JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JEAN
Last Name:RODON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501B W ASH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-442-4161
Mailing Address - Fax:573-442-4162
Practice Address - Street 1:2501B W ASH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-442-4161
Practice Address - Fax:573-442-4162
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01536103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5096888OtherCCN
MO1088760OtherFIRST HEALTH
MO251104OtherCOMPSYCH
MO074664OtherVALUE OPTIONS
MO109489OtherBLUE CROSS BLUE SHIELD
MO61-43032OtherUNITED HEALTHCARE