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1277 Kelly Johnson Blvd Ste 160 Colorado Springs CO 80920-3992 | |
| (719) 257-3540 | |
| (720) 753-5197 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1277 Kelly Johnson Blvd Ste 160, Colorado Springs, Colorado |
| Authorized Official Name and Position | Candace Rodgers (OWNER/THERAPIST) |
| Authorized Official Contact | 7192573540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1522 Lyle Dr Colorado Springs CO 80915-2048 Ph: (970) 580-4249 | 1277 Kelly Johnson Blvd Ste 160 Colorado Springs CO 80920-3992 Ph: (719) 257-3540 |
| NPI Number | 1558098699 |
|---|---|
| Provider Enumeration Date | 08/08/2022 |
| Last Update Date | 12/11/2024 |
| Certification Date | 12/11/2024 |
| Medicare PECOS PAC ID | 2062943178 |
|---|---|
| Medicare Enrollment ID | O20241001000175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558098699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Candace Joy Rodgers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093382830 PECOS PAC ID: 3971034083 Enrollment ID: I20241001004329 |
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