Provider Demographics
NPI:1881390896
Name:RODRIGUEZ, KATELYN ELIZABETH (QIDP, CMHP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:QIDP, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 HIGHPOINT DR APT 3
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8774
Mailing Address - Country:US
Mailing Address - Phone:269-257-1611
Mailing Address - Fax:
Practice Address - Street 1:630 HIGHPOINT DR APT 3
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-8774
Practice Address - Country:US
Practice Address - Phone:269-257-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator