Provider Demographics
NPI:1376274860
Name:RODRIGUEZ, ALEXIS SABRINA
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:SABRINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CHRISTINE WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6139
Mailing Address - Country:US
Mailing Address - Phone:773-551-5676
Mailing Address - Fax:
Practice Address - Street 1:246 CHRISTINE WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6139
Practice Address - Country:US
Practice Address - Phone:773-551-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1067601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical