Provider Demographics
NPI:1962757583
Name:RODRIGUEZ, KELLI CHRISTINE (AUD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:CHRISTINE
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 1:820 CHARLEVOIX DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8188
Mailing Address - Country:US
Mailing Address - Phone:175-627-3202
Mailing Address - Fax:517-627-3203
Practice Address - Street 1:310 N CLIPPERT ST
Practice Address - Street 2:STE. 4
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4694
Practice Address - Country:US
Practice Address - Phone:517-332-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000615231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist