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NPI Code Detail

MEDICARE: LISA RODRIGUEZ SLP

MEDICARE: LISA RODRIGUEZ SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2036MA

General Provider Information

NPI Number : 1710040670
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RODRIGUEZ SLP
Provider Business Mailing Address
First Line : 801 PLEASANT ST
Second Line :
City : BROCKTON
State : MA
Zip : 02301-3052
Country : US
Telephone Number : 508-586-9855
Fax Number :
Provider Business Practice Location Address
First Line : 801 PLEASANT ST
Second Line :
City : BROCKTON
State : MA
Zip : 02301-3052
Country : US
Telephone Number : 508-586-9855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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Directions to “ LISA RODRIGUEZ SLP” Practice Location

Language Start Address Practice Location
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