Individual
STACEY LYNN RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
555 N WOODLAWN ST, STE 3105, WICHITA, KS 67208-3673
(316) 651-1230
(316) 685-0768
Mailing address
555 N WOODLAWN ST, STE 3105, WICHITA, KS 67208-3673
(316) 651-1230
(316) 685-0768
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2327
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071010
BCBS PROVIDER NUMBER
KS
Enumeration date
11/18/2005
Last updated
08/22/2016
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