Healthcare Provider Details

I. General information

NPI: 1750463790
Provider Name (Legal Business Name): CARRIE ANN RODRIGUEZ M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 MAIDEN GRASS RD NW
ALBUQUERQUE NM
87120-6239
US

IV. Provider business mailing address

2519 MAIDEN GRASS RD NW
ALBUQUERQUE NM
87120-6239
US

V. Phone/Fax

Practice location:
  • Phone: 505-362-1469
  • Fax: 505-352-9213
Mailing address:
  • Phone: 505-362-1469
  • Fax: 505-352-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2687
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: