Provider Demographics
NPI:1528798964
Name:RODEN, MARY GRACE (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:RODEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 AMESBURY DR APT 432
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4335
Mailing Address - Country:US
Mailing Address - Phone:256-590-6206
Mailing Address - Fax:
Practice Address - Street 1:2201 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7320
Practice Address - Country:US
Practice Address - Phone:214-645-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty