Provider Demographics
NPI:1710453097
Name:RODRIGUEZ, DANIEL W
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE 109TH AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7242
Mailing Address - Country:US
Mailing Address - Phone:503-758-5712
Mailing Address - Fax:
Practice Address - Street 1:707 NE COUCH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2922
Practice Address - Country:US
Practice Address - Phone:503-542-4603
Practice Address - Fax:503-233-6093
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker