Individual
MISTY ROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 WESTEN ST, BOWLING GREEN, KY 42104-3352
(270) 904-1072
(270) 904-1073
Mailing address
1312 WESTEN ST, BOWLING GREEN, KY 42104-3352
(270) 904-1072
(270) 904-1073
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
255040
KENTUCKY SOCIAL WORK BOARD LCSW
KY
05
—
7100679350
—
KY
Enumeration date
04/25/2012
Last updated
07/31/2020
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