Provider Demographics
NPI:1386760486
Name:WALLETTE, RODNEY JAMES (MS, CRC)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:JAMES
Last Name:WALLETTE
Suffix:
Gender:M
Credentials:MS, CRC
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Mailing Address - Street 1:595 PATRICK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7526
Mailing Address - Country:US
Mailing Address - Phone:406-755-4883
Mailing Address - Fax:406-751-4145
Practice Address - Street 1:205 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3120
Practice Address - Country:US
Practice Address - Phone:406-751-4189
Practice Address - Fax:406-751-4527
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
31731 CRCC225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor