Provider Demographics
NPI:1780739177
Name:RODRIGUEZ, KAREN A (LISW, LMHP, CMSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LISW, LMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:IA
Mailing Address - Zip Code:51521-0399
Mailing Address - Country:US
Mailing Address - Phone:712-307-6014
Mailing Address - Fax:712-307-6015
Practice Address - Street 1:118 N ELM ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:IA
Practice Address - Zip Code:51521-0399
Practice Address - Country:US
Practice Address - Phone:712-307-6014
Practice Address - Fax:712-307-6015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06578101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA816656000Medicaid
IA06578OtherLISW
NE1110OtherCMSW
NE2705OtherLMHP