Individual
STEPHANY MELISSA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4412 6TH AVE, TACOMA, WA 98406-3500
(253) 393-0369
Mailing address
5105 GRAND LOOP UNIT 614, TACOMA, WA 98407-3197
(253) 393-0369
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
WDL118RGF5SB
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015302576-01
TRICARE
WA
Enumeration date
02/25/2020
Last updated
02/25/2020
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