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NPI Code Detail

MEDICARE: AMANDA NICOLE RODRIGUEZ

MEDICARE: AMANDA NICOLE 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
1103K00000XBehavior Analyst1-22-59517GA
22355S0801XSpeech-Language AssistantSI 2451FL

General Provider Information

NPI Number : 1790210151
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NICOLE RODRIGUEZ
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 2651 DALLAS HWY SW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-2541
Country : US
Telephone Number : 678-486-1904
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2017
Last Update Date : 08/18/2022

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Directions to “ AMANDA NICOLE RODRIGUEZ ” Practice Location

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