Provider Demographics
NPI:1942854252
Name:RODRIGUEZ, EMILEE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVER STREET N.
Mailing Address - Street 2:PO BOX 519
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328
Mailing Address - Country:US
Mailing Address - Phone:612-440-2093
Mailing Address - Fax:
Practice Address - Street 1:1 PREMIER DR STE 220
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-5400
Practice Address - Country:US
Practice Address - Phone:612-440-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist