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General NPI Number Information
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NPI Number | 1265063481
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Entity Type | Individual
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Provider Name | LISA CHRISTINE RODRIGUEZ BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 2040 RAYBROOK ST SE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7718
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Country | US
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Telephone | 801-251-6148
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Fax | 162-856-0636
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Provider Business Mailing Address
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Address Line | 7676 STEELE AVE
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City | JENISON
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State | MI
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Zip | 49428-7981
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Country | US
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Telephone | 616-322-8456
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401001039
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License Number State | MI
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