Provider Demographics
NPI:1669967709
Name:RODRIGUEZ, JOSIE J (SLP-A)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:J
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP-A
Mailing Address - Street 1:14201 W SUNRISE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-756-2818
Mailing Address - Fax:954-514-1126
Practice Address - Street 1:14201 W SUNRISE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-756-2818
Practice Address - Fax:954-514-1126
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI36092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI3609Medicaid