Healthcare Provider Details

I. General information

NPI: 1851208722
Provider Name (Legal Business Name): MARIAH MIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 HOBSON RD STE B
WOODRIDGE IL
60517-1689
US

IV. Provider business mailing address

100 RENAISSANCE BLVD
OAKBROOK TERRACE IL
60181-4806
US

V. Phone/Fax

Practice location:
  • Phone: 630-381-7755
  • Fax: 630-381-7755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: