Provider Demographics
NPI:1184024739
Name:RODRIGUEZ, JONI LYN (MA)
Entity Type:Individual
Prefix:MS
First Name:JONI
Middle Name:LYN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JONI
Other - Middle Name:LYN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:98 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7487
Mailing Address - Country:US
Mailing Address - Phone:386-264-6241
Mailing Address - Fax:
Practice Address - Street 1:98 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7487
Practice Address - Country:US
Practice Address - Phone:386-264-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health