Provider Demographics
NPI:1386093722
Name:RODRIGUEZ, PAULA JEAN (HIS)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 GALLOWAY ST.
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703
Mailing Address - Country:US
Mailing Address - Phone:906-789-4327
Mailing Address - Fax:906-789-0855
Practice Address - Street 1:1802 GALLOWAY ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3467
Practice Address - Country:US
Practice Address - Phone:906-789-4327
Practice Address - Fax:906-789-0855
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501005072237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist