Healthcare Provider Details

I. General information

NPI: 1669731311
Provider Name (Legal Business Name): CONNI BETH RODRIGUEZ AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-894-6615
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-894-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2043
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: