Provider Demographics
NPI:1033825104
Name:WRIGHT, RODERICK (SLP)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 LAKE MICHIGAN DR # 103
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9244
Mailing Address - Country:US
Mailing Address - Phone:616-990-9284
Mailing Address - Fax:
Practice Address - Street 1:9662 64TH AVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9314
Practice Address - Country:US
Practice Address - Phone:616-990-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLPCF22006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist