Provider Demographics
NPI:1104942960
Name:RODELLO, LAURA M (BED, QMHA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:RODELLO
Suffix:
Gender:F
Credentials:BED, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 FORSYTHIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7712
Mailing Address - Country:US
Mailing Address - Phone:541-868-0661
Mailing Address - Fax:541-868-0660
Practice Address - Street 1:1790 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3780
Practice Address - Country:US
Practice Address - Phone:541-868-0661
Practice Address - Fax:541-868-0660
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker