Provider Demographics
NPI:1538840053
Name:RODRIGUEZ, AMANDA JENELLE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JENELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JENELLE
Other - Last Name:ESTRELLA-GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:14207 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2709
Mailing Address - Country:US
Mailing Address - Phone:510-220-9578
Mailing Address - Fax:
Practice Address - Street 1:14207 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2709
Practice Address - Country:US
Practice Address - Phone:510-220-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant