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NPI Code Detail

MEDICARE: MRS. JEANNA MARIE RODRIGUEZ

MEDICARE: MRS. JEANNA MARIE RODRIGUEZ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1740125111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNA MARIE RODRIGUEZ
Provider Business Mailing Address
First Line : 5039 VILLA LINDE PKWY STE 30
Second Line : SUITE #30
City : FLINT
State : MI
Zip : 48532-3450
Country : US
Telephone Number : 989-401-2244
Fax Number :
Provider Business Practice Location Address
First Line : 28241 MOUND RD STE C
Second Line :
City : WARREN
State : MI
Zip : 48092-5523
Country : US
Telephone Number : 989-401-2244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2026
Last Update Date : 04/22/2026

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