Provider Information for 1952177461
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JESSICA CATHERINE RODRIGUEX WELLMAKER LCPC, ASOP
Sex: Female
NPI: 1952177461
Last Updated: 2023-11-28
Certification Date: 2023-11-28
Certification Date: 2023-11-28
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1952177461 | ||||||||
| Enumeration Date | 2023-11-27 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 906 MAPLE ST MOUNT VERNON, IL 62864-3547 United States Phone: 408-656-0623 | Fax: | ||||||||
| Primary Practice Address | 1720 BROADWAY ST MOUNT VERNON, IL 62864-2930 United States Phone: 408-656-0623 | Fax: | ||||||||
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