Provider Demographics
NPI:1962890475
Name:RODRIGUEZ, MONICA (LPC, MAC, MA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC, MAC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E. FOREST STREET
Mailing Address - Street 2:SUITE 119
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-490-3894
Mailing Address - Fax:
Practice Address - Street 1:405 EAST FOREST STREET
Practice Address - Street 2:SUITE 119
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-490-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5807-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100048954Medicaid