Provider Demographics
NPI:1700852670
Name:ROHDEN, SUSAN K (LISW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:ROHDEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:NICOLAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1601 MILITARY ROAD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-1715
Mailing Address - Country:US
Mailing Address - Phone:712-252-4547
Mailing Address - Fax:712-252-3785
Practice Address - Street 1:1321 2ND AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4925
Practice Address - Country:US
Practice Address - Phone:515-576-4156
Practice Address - Fax:515-576-6998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02616104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
43766OtherWELLMARK