Provider Demographics
NPI:1326279910
Name:RODRIGUEZ, JOSUE HERMENEGILDO (SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:HERMENEGILDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:HERMENEGUILDO
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3412 SAINT HONORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0640
Mailing Address - Country:US
Mailing Address - Phone:956-655-3614
Mailing Address - Fax:
Practice Address - Street 1:5215 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2202
Practice Address - Country:US
Practice Address - Phone:956-803-0033
Practice Address - Fax:956-683-6448
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105841235Z00000X
TX2417103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167033301Medicaid