Provider Demographics
NPI:1467297085
Name:PAM RODELY
Entity type:Organization
Organization Name:PAM RODELY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RODELY
Authorized Official - Suffix:
Authorized Official - Credentials:PATH CERTIFIED
Authorized Official - Phone:618-607-4110
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0520
Mailing Address - Country:US
Mailing Address - Phone:618-607-4110
Mailing Address - Fax:
Practice Address - Street 1:830 ROWAN RD
Practice Address - Street 2:
Practice Address - City:MAKANDA
Practice Address - State:IL
Practice Address - Zip Code:62958-2849
Practice Address - Country:US
Practice Address - Phone:618-303-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health