Provider Demographics
NPI:1639554595
Name:RODRIGUEZ, ALEXANDREA
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E VAN BUREN ST
Mailing Address - Street 2:APT 1071
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4007
Mailing Address - Country:US
Mailing Address - Phone:847-525-3279
Mailing Address - Fax:
Practice Address - Street 1:901 E VAN BUREN ST
Practice Address - Street 2:APT 1071
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4007
Practice Address - Country:US
Practice Address - Phone:847-525-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP9538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist