Provider Demographics
NPI:1922018365
Name:RODD, JESSICA J (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:RODD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 TALCOTT RD
Mailing Address - Street 2:C/O ASSOCIATES AT THE GABLES SUITE 206
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2089
Mailing Address - Country:US
Mailing Address - Phone:802-876-1100
Mailing Address - Fax:802-876-1101
Practice Address - Street 1:183 TALCOTT RD
Practice Address - Street 2:C/O ASSOCIATES AT THE GABLES SUITE 206
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2089
Practice Address - Country:US
Practice Address - Phone:802-876-1100
Practice Address - Fax:802-876-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900002731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008866Medicaid
VT18079OtherBLUE CROSS BLUE SHIELD