Provider Demographics
NPI:1740633023
Name:RODABOUGH, CRAIG B (MS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:RODABOUGH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 N CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8882
Mailing Address - Country:US
Mailing Address - Phone:801-633-3653
Mailing Address - Fax:
Practice Address - Street 1:926 N CATALPA DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8882
Practice Address - Country:US
Practice Address - Phone:801-633-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333856-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist