Provider Demographics
NPI:1386295327
Name:RODRIGUEZ, ANDREA (SLPA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1632 S HAYWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4514
Mailing Address - Country:US
Mailing Address - Phone:562-745-5583
Mailing Address - Fax:
Practice Address - Street 1:5450 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3994
Practice Address - Country:US
Practice Address - Phone:877-757-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant