Provider Demographics
NPI:1336484187
Name:RODRIGUEZ, TRISHA (SACIT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-928-4402
Mailing Address - Fax:
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-928-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16744-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)