Provider Demographics
NPI:1225716319
Name:RODRIGUEZ CANELON, YESICA (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:YESICA
Middle Name:
Last Name:RODRIGUEZ CANELON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2759
Mailing Address - Country:US
Mailing Address - Phone:413-335-7741
Mailing Address - Fax:
Practice Address - Street 1:1 N MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2759
Practice Address - Country:US
Practice Address - Phone:413-335-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency