Provider Demographics
NPI:1962625905
Name:RODRIGUEZ, BRENDA G (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:G
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 RAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5115
Mailing Address - Country:US
Mailing Address - Phone:941-927-8805
Mailing Address - Fax:
Practice Address - Street 1:5881 RAND BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5115
Practice Address - Country:US
Practice Address - Phone:941-927-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist