Provider Demographics
NPI:1023113198
Name:RODRIGUEZ, ELIZABETH C (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32443 WATERFORD CREST LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-3003
Mailing Address - Country:US
Mailing Address - Phone:832-563-3225
Mailing Address - Fax:281-346-8090
Practice Address - Street 1:32443 WATERFORD CREST LN
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-3003
Practice Address - Country:US
Practice Address - Phone:832-563-3225
Practice Address - Fax:281-346-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177729401Medicaid