Provider Demographics
NPI:1598365520
Name:RODRIGUEZ, SHERENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERENE
Middle Name:
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 1:4709 RAMS HEAD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1142
Mailing Address - Country:US
Mailing Address - Phone:301-284-8572
Mailing Address - Fax:
Practice Address - Street 1:4709 RAMS HEAD CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-1142
Practice Address - Country:US
Practice Address - Phone:012-284-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist