Provider Demographics
NPI:1225505969
Name:RODRIGUEZ, BEVERLY ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36161 RICHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLARDS
Mailing Address - State:MD
Mailing Address - Zip Code:21874-1137
Mailing Address - Country:US
Mailing Address - Phone:410-677-5819
Mailing Address - Fax:
Practice Address - Street 1:36161 RICHLAND RD
Practice Address - Street 2:
Practice Address - City:WILLARDS
Practice Address - State:MD
Practice Address - Zip Code:21874-1137
Practice Address - Country:US
Practice Address - Phone:410-677-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist