Individual
MR. JOSE RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1478 KENWOOD DR, SUITE 1, MENASHA, WI 54952-1161
(920) 886-9319
(920) 886-9357
Mailing address
410 W 10TH AVE, P. O. BOX 2145, OSHKOSH, WI 54903-2145
(920) 886-9319
(920) 886-9357
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12601
WI
101YP2500X
Professional Counselor
278
WI
1041C0700X
Clinical Social Worker
Primary
1883
WI
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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