Provider Demographics
NPI:1861965519
Name:RODGERS, SHANNON J (LADC, LCMHC)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:J
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 JONES RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1139
Practice Address - Country:US
Practice Address - Phone:802-793-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)