Provider Demographics
NPI:1558608364
Name:RODRIGUEZ, SOIDE Y (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SOIDE
Middle Name:Y
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials: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:HC 15 BOX 15049
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9472
Mailing Address - Country:US
Mailing Address - Phone:860-752-9460
Mailing Address - Fax:
Practice Address - Street 1:HC 15 BOX 15049
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9472
Practice Address - Country:US
Practice Address - Phone:860-752-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist