Provider Demographics
NPI:1740630649
Name:RODRIGUE, TRICIA (SLP)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 APPLETREE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-9418
Mailing Address - Country:US
Mailing Address - Phone:225-253-8709
Mailing Address - Fax:985-633-9269
Practice Address - Street 1:130 APPLETREE DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-9418
Practice Address - Country:US
Practice Address - Phone:225-253-8709
Practice Address - Fax:985-633-9269
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist