Provider Demographics
NPI:1538490826
Name:RODRIGUEZ, JENNIFER ALICIA (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALICIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 REDSKIN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3380
Mailing Address - Country:US
Mailing Address - Phone:956-377-5155
Mailing Address - Fax:956-377-5123
Practice Address - Street 1:2010 REDSKIN AVE
Practice Address - Street 2:STE A
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3380
Practice Address - Country:US
Practice Address - Phone:956-377-5155
Practice Address - Fax:956-377-5123
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208350301Medicaid