Basic Information
| Provider Information | |||||||||
| NPI: | 1659508661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | LYNDSEY | ||||||||
| MiddleName: | ALLISON | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7300 CRYSTAL LAKE DR APT 12 | ||||||||
| Address2: | |||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484738954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106918869 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1110 ELDON BAKER DR | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485071923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102131803 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801089282 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.