Provider Demographics
NPI:1861022295
Name:RODRIGUEZ, SYLVIA VIRGINIA
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:VIRGINIA
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 1:514 WINTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3460
Mailing Address - Country:US
Mailing Address - Phone:630-433-1953
Mailing Address - Fax:
Practice Address - Street 1:514 WINTERWOOD DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3460
Practice Address - Country:US
Practice Address - Phone:630-433-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician