Healthcare Provider Details

I. General information

NPI: 1053003830
Provider Name (Legal Business Name): ASHLEY MARIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 W 116TH ST
CLEVELAND OH
44111-1740
US

IV. Provider business mailing address

3222 W 116TH ST
CLEVELAND OH
44111-1740
US

V. Phone/Fax

Practice location:
  • Phone: 216-316-4908
  • Fax:
Mailing address:
  • Phone: 216-316-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberSW149826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: