Provider Demographics
NPI:1184878563
Name:CAROLE J RODON, PHD, PC
Entity type:Organization
Organization Name:CAROLE J RODON, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-442-4161
Mailing Address - Street 1:2501B W ASH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-442-4161
Mailing Address - Fax:
Practice Address - Street 1:2501B W ASH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-442-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1088760OtherFIRST HEALTH
MO109489OtherANTHEM BLUE CROSS BLUE SHIELD
MO61-43032OtherUNITED HEALTHCARE
MO074664OtherVALUE OPTIONS
MO61-43032OtherUNITED HEALTHCARE