Provider Demographics
NPI:1720112725
Name:RODINSKY, WANDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:RODINSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:LOU
Other - Last Name:TRIPLETT LANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 SE 22ND ST STE 14
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4311
Mailing Address - Country:US
Mailing Address - Phone:479-367-2552
Mailing Address - Fax:479-367-2584
Practice Address - Street 1:200 SE 22ND ST STE 14
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4311
Practice Address - Country:US
Practice Address - Phone:479-367-2552
Practice Address - Fax:479-367-2584
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004449104100000X
AR2003-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1720112725Medicaid
OK200954690Medicaid