MEDICARE: CHRISTIANNE RODRIGUEZ M.A. CCC-SLP

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	6022	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477952125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANNE RODRIGUEZ M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	505 S MAIN ST STE 249
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 N ROADRUNNER PKWY APT 1803
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8126
Country	:	US
Telephone Number	:	575-527-5823
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	09/01/2016

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Directions to “ CHRISTIANNE RODRIGUEZ M.A. CCC-SLP” Practice Location

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