Provider Demographics
NPI:1932143955
Name:RODRIGUEZ, JUANITA MARIE (LADC,NCAC I,Q-SAP,)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LADC,NCAC I,Q-SAP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 KINGSGATE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4824
Mailing Address - Country:US
Mailing Address - Phone:308-635-7707
Mailing Address - Fax:
Practice Address - Street 1:1321 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3579
Practice Address - Country:US
Practice Address - Phone:308-632-7411
Practice Address - Fax:308-632-7423
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)