Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 22 | WI |
NPI | 1134502164 |
---|---|
Provider Name | Nicholas James Rodgers I |
First Address | West Allis, WI 53227-1031 |
Second Address | West Allis, WI 53227-1031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 08/07/2015 |