Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225X00000X | Occupational Therapist | 11821070-4201 | UT |
N | 225XM0800X | Mental Health |
NPI | 1356649081 |
---|---|
Provider Name | Stevie Alexis Rodriguez |
First Address | Salt Lake City, UT 84124-3550 |
Second Address | Salt Lake City, UT 84124-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2011 |
Last Update Date | 20/12/2021 |