Provider Demographics
NPI:1710232186
Name:RODRIGUEZ, MARY N (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
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:PO BOX 9292
Mailing Address - Street 2:9550 PINECREST DR.
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77387-9292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:832-201-9787
Practice Address - Street 1:9450 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3220
Practice Address - Country:US
Practice Address - Phone:773-386-0683
Practice Address - Fax:832-201-9787
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist