MEDICARE: CECILIA RODRIGUEZ SLPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SLPA9542	AZ

General Provider Information

NPI Number	:	1063969939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA RODRIGUEZ SLPA

Provider Business Mailing Address
First Line	:	7121 W WINSLOW AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7805
Country	:	US
Telephone Number	:	623-229-8317
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 W WINSLOW AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7805
Country	:	US
Telephone Number	:	623-229-8317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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