Healthcare Provider Details

I. General information

NPI: 1669394102
Provider Name (Legal Business Name): HANNIA MICHELL GODINEZ RODRIGUEZ MA CCC-SLP, TSSLD BE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 164TH ST
BRONX NY
10456-6327
US

IV. Provider business mailing address

1065 MANOR AVE APT 5B
BRONX NY
10472-5918
US

V. Phone/Fax

Practice location:
  • Phone: 347-867-9307
  • Fax:
Mailing address:
  • Phone: 347-867-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: