Provider Information for 1639208952
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RODNEY ALLEN SMITH CADC II
Sex: Male
NPI: 1639208952
Last Updated: 2023-07-15
Certification Date: 2023-07-15
Certification Date: 2023-07-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639208952 | ||||||||||||
| Enumeration Date | 2007-03-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2072 E BENNETT ST APT F15 SPRINGFIELD, MO 65804-1758 United States Phone: 907-841-4091 | Fax: | ||||||||||||
| Primary Practice Address | 3041 GEHLAR RD NW 1043 SALEM, OR 97304-4289 United States Phone: 503-980-3438 | Fax: | ||||||||||||
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