Provider Demographics
NPI:1710520267
Name:RODRIGUEZ, LAURA B
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
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 1:3974 W RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4180
Mailing Address - Country:US
Mailing Address - Phone:801-671-6607
Mailing Address - Fax:
Practice Address - Street 1:2880 W 4700 S STE G1
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2156
Practice Address - Country:US
Practice Address - Phone:801-990-4300
Practice Address - Fax:801-967-2127
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health