Provider Demographics
NPI:1053617951
Name:RODRIGUEZ, LISA RAMON (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RAMON
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 S. BROWNLEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3134
Mailing Address - Country:US
Mailing Address - Phone:361-980-9652
Mailing Address - Fax:361-993-8509
Practice Address - Street 1:1630 S. BROWNLEE BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3134
Practice Address - Country:US
Practice Address - Phone:361-980-9652
Practice Address - Fax:361-993-8509
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist