Provider Demographics
NPI:1083395396
Name:RODRIGUEZ, KATIE LEDFORD
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEDFORD
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BRUSHY MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7234
Mailing Address - Country:US
Mailing Address - Phone:803-493-7917
Mailing Address - Fax:
Practice Address - Street 1:507 PATRIOT LN
Practice Address - Street 2:
Practice Address - City:EDGEMOOR
Practice Address - State:SC
Practice Address - Zip Code:29712-8704
Practice Address - Country:US
Practice Address - Phone:803-367-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist