Provider Demographics
NPI:1306960885
Name:RODRIGUES, ANGIE DICKENS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:DICKENS
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 STAR MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-8214
Mailing Address - Country:US
Mailing Address - Phone:870-448-6740
Mailing Address - Fax:870-448-2510
Practice Address - Street 1:2162 STAR MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-8214
Practice Address - Country:US
Practice Address - Phone:870-448-6740
Practice Address - Fax:870-448-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist