Provider Demographics
NPI:1417377292
Name:RODRIGUEZ, EVELYN MARTHA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MARTHA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:EVELYN
Other - Middle Name:MARTHA
Other - Last Name:RODRIGUEZ-ANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 BEACON ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5685
Mailing Address - Country:US
Mailing Address - Phone:617-512-4139
Mailing Address - Fax:
Practice Address - Street 1:1051 BEACON ST
Practice Address - Street 2:SUITE 511
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5685
Practice Address - Country:US
Practice Address - Phone:617-512-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist