Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 180-005910 | IL |
Y | 225XG0600X | Occupational Therapist - Gerontology | 056009263 | IL |
NPI | 1942212873 |
---|---|
Provider Name | Ms. Julia D. Rodriguez |
First Address | Clarendon Hills, IL 60514 |
Second Address | Clarendon Hills, IL 60514-1578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 01/07/2014 |