Individual
MRS. AMANDA MARIA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC, CSIT
Contact information
Practice address
5735 DURAND AVE, MOUNT PLEASANT, WI 53406-5011
(262) 598-1392
(262) 598-1395
Mailing address
5735 DURAND AVE, MOUNT PLEASANT, WI 53406-5011
(262) 598-1392
(262) 598-1395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15693-133
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16021-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100037952
—
WI
Enumeration date
04/23/2013
Last updated
11/08/2017
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