Healthcare Provider Details

I. General information

NPI: 1184180788
Provider Name (Legal Business Name): ANDREA RODHOUSE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 JESUS WAY
SARASOTA FL
34240-9405
US

IV. Provider business mailing address

2250 JESUS WAY
SARASOTA FL
34240-9405
US

V. Phone/Fax

Practice location:
  • Phone: 810-869-0347
  • Fax: 855-232-8604
Mailing address:
  • Phone: 810-869-0347
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: