Provider Demographics
NPI:1992981617
Name:RODRIGUEZ, TERESA (SLP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:17900 NW 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2808
Mailing Address - Country:US
Mailing Address - Phone:954-435-9905
Mailing Address - Fax:954-435-3769
Practice Address - Street 1:17900 NW 5TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2808
Practice Address - Country:US
Practice Address - Phone:954-435-9905
Practice Address - Fax:954-435-3769
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist