Provider Demographics
NPI:1548422967
Name:RODRIGUE, SOMMER L (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:SOMMER
Middle Name:L
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ELM CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4745
Mailing Address - Country:US
Mailing Address - Phone:601-790-4142
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST WOODROW WILSON DRIVE
Practice Address - Street 2:GV SONNY MONTGOMERY DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5199
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist