Healthcare Provider Details

I. General information

NPI: 1184534570
Provider Name (Legal Business Name): JENNIFER RODRIGUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 UPPER RIVERDALE RD SW
RIVERDALE GA
30274-2634
US

IV. Provider business mailing address

1724 WESLEY WAY NW APT B
CONYERS GA
30012-4032
US

V. Phone/Fax

Practice location:
  • Phone: 855-724-9356
  • Fax:
Mailing address:
  • Phone: 404-690-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-494258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: