Provider Demographics
NPI:1396146098
Name:DUDGEON, ROD (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:DUDGEON
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1211
Mailing Address - Country:US
Mailing Address - Phone:419-399-4711
Mailing Address - Fax:419-399-3346
Practice Address - Street 1:202 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1211
Practice Address - Country:US
Practice Address - Phone:419-399-4711
Practice Address - Fax:419-399-3346
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIN 1006463103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral