Provider Demographics
NPI:1386156040
Name:RODRIGUEZ ROMO, MARIA X (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:X
Last Name:RODRIGUEZ ROMO
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 1:7254 S LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4345
Mailing Address - Country:US
Mailing Address - Phone:773-807-1459
Mailing Address - Fax:
Practice Address - Street 1:200 SKILES BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7321
Practice Address - Country:US
Practice Address - Phone:800-578-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist