Provider Demographics
NPI:1265063481
Name:RODRIGUEZ, LISA CHRISTINE (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7981
Mailing Address - Country:US
Mailing Address - Phone:616-322-8456
Mailing Address - Fax:
Practice Address - Street 1:2040 RAYBROOK ST SE STE 300
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7718
Practice Address - Country:US
Practice Address - Phone:801-251-6148
Practice Address - Fax:162-856-0636
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001039103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst