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General NPI Number Information
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NPI Number | 1154887396
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Entity Type | Individual
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Provider Name | TAMMY AVA RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 400 E MAIN ST
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City | ALICE
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State | TX
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Zip | 78332-4969
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Country | US
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Telephone | 361-396-4029
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 E NETTIE AVE
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City | KINGSVILLE
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State | TX
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Zip | 78363-4052
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Country | US
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Telephone | 361-389-8654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 40878
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License Number State | TX
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