MEDICARE: KOURTNEY L RODRIGUEZ

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	235Z00000X	Speech-Language Pathologist	10836	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10836	OTHER	NC	NORTH CAROLINA BOARD OF EXAMINERS SLP

General Provider Information

NPI Number	:	1306266218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOURTNEY L RODRIGUEZ

Provider Business Mailing Address
First Line	:	6316 GAINSBOROUGH DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-6615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6316 GAINSBOROUGH DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-6615
Country	:	US
Telephone Number	:	207-323-1276
Fax Number	:

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	06/17/2026

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Directions to “ KOURTNEY L RODRIGUEZ ” Practice Location

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