Provider Demographics
NPI:1336980390
Name:RODRIGUEZ, IVELCA (AUD)
Entity type:Individual
Prefix:
First Name:IVELCA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 KENNEDY BLVD STE 4S
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5345
Mailing Address - Country:US
Mailing Address - Phone:201-472-8500
Mailing Address - Fax:201-472-8501
Practice Address - Street 1:8901 KENNEDY BLVD STE 4S
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5345
Practice Address - Country:US
Practice Address - Phone:201-472-8500
Practice Address - Fax:201-472-8501
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00130100231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist