Provider Demographics
NPI:1215285002
Name:RODRIGUEZ, CAMILLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 WARBURTON AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1621
Mailing Address - Country:US
Mailing Address - Phone:917-841-3259
Mailing Address - Fax:
Practice Address - Street 1:701 SAINT ANNS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1446
Practice Address - Country:US
Practice Address - Phone:718-993-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist