Provider Demographics
NPI:1134331879
Name:RODRIGUEZ, JESSICA (THL)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AVE COSTA NORTE
Mailing Address - Street 2:ATLANTIC VIEW
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-6125
Mailing Address - Country:US
Mailing Address - Phone:787-317-2826
Mailing Address - Fax:787-858-2818
Practice Address - Street 1:D39 MARGINAL
Practice Address - Street 2:URB VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-2818
Practice Address - Fax:787-858-2818
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant