Provider Demographics
NPI:1356585913
Name:RODRIGUEZ, WENDY (MS TSHH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 LODOVICK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6246
Mailing Address - Country:US
Mailing Address - Phone:718-666-7735
Mailing Address - Fax:
Practice Address - Street 1:2454 LODOVICK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6246
Practice Address - Country:US
Practice Address - Phone:718-666-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1720666235Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program