Provider Demographics
NPI:1720560022
Name:RODRICK, JENNIFER ELLEN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:RODRICK
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 1:2040 FRASCATI DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3968
Mailing Address - Country:US
Mailing Address - Phone:916-524-9191
Mailing Address - Fax:
Practice Address - Street 1:1002 RIVER ROCK DR STE 130
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2094
Practice Address - Country:US
Practice Address - Phone:916-351-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist