Provider Demographics
NPI:1427187228
Name:RODRIGUEZ, MELISSA M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 SHREYA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1786
Mailing Address - Country:US
Mailing Address - Phone:915-490-9638
Mailing Address - Fax:
Practice Address - Street 1:1014 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4109
Practice Address - Country:US
Practice Address - Phone:915-230-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174258701Medicaid