Provider Demographics
NPI:1063251361
Name:AVERY, RODNEY
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:AVERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 N REYNARD RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320-9106
Mailing Address - Country:US
Mailing Address - Phone:765-283-4329
Mailing Address - Fax:
Practice Address - Street 1:234 W PEARL ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:IN
Practice Address - Zip Code:47336-1430
Practice Address - Country:US
Practice Address - Phone:765-896-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician