Provider Demographics
NPI:1205274271
Name:RODRIGUEZ, KELLIE LYNN (CCC-SLP, MS)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:RODRIGUEZ
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Gender:F
Credentials:CCC-SLP, MS
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Mailing Address - Street 1:3620 N. JOSEY LANE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3159
Mailing Address - Country:US
Mailing Address - Phone:469-892-7500
Mailing Address - Fax:888-237-2214
Practice Address - Street 1:3630 N JOSEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3159
Practice Address - Country:US
Practice Address - Phone:469-892-7500
Practice Address - Fax:888-237-7500
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2014-07-30
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Provider Licenses
StateLicense IDTaxonomies
TX19728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist