Provider Demographics
NPI:1942866256
Name:RODRIGUEZ, ANA CAREN
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CAREN
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 1:350 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2340
Mailing Address - Country:US
Mailing Address - Phone:815-618-5019
Mailing Address - Fax:
Practice Address - Street 1:350 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2340
Practice Address - Country:US
Practice Address - Phone:815-618-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician