Provider Demographics
NPI:1942577028
Name:ANODYNE THERAPY, LLC
Entity Type:Organization
Organization Name:ANODYNE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:KITTIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-529-0732
Mailing Address - Street 1:504 N WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5654
Mailing Address - Country:US
Mailing Address - Phone:573-529-0732
Mailing Address - Fax:
Practice Address - Street 1:1007 N COLLEGE AVE
Practice Address - Street 2:STE #1
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4794
Practice Address - Country:US
Practice Address - Phone:573-529-0732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0026901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497810218Medicaid