Provider Demographics
NPI:1619443892
Name:RODRIGUEZ, SOLEDAD LEGARDA
Entity type:Individual
Prefix:MRS
First Name:SOLEDAD
Middle Name:LEGARDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 52ND ST APT 2219
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7955
Mailing Address - Country:US
Mailing Address - Phone:602-315-9946
Mailing Address - Fax:
Practice Address - Street 1:815 N 52ND ST APT 2219
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7955
Practice Address - Country:US
Practice Address - Phone:602-315-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA115232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA11523OtherSLPA