Healthcare Provider Details

I. General information

NPI: 1609799436
Provider Name (Legal Business Name): SAN JUANITA RODRIGUEZ ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST S
WISCONSIN RAPIDS WI
54494-5413
US

IV. Provider business mailing address

1801 16TH ST S
WISCONSIN RAPIDS WI
54494-5413
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-6750
  • Fax: 715-424-6754
Mailing address:
  • Phone: 715-424-6750
  • Fax: 715-424-6754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number908649
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: