Provider Demographics
NPI:1619786662
Name:RODRIGUEZ, AIMEE (MA)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5123 UTAH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1669
Mailing Address - Country:US
Mailing Address - Phone:907-738-4689
Mailing Address - Fax:
Practice Address - Street 1:5123 UTAH AVE APT B
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1669
Practice Address - Country:US
Practice Address - Phone:907-738-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 172V00000X, 101YM0800X, 374J00000X
OR10447606174400000X, 252Y00000X
AK4093098174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency