Individual
ELIZABETH J RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4209 N 18TH EAST ST, MOUNTAIN HOME, ID 83647-5899
(208) 599-0944
Mailing address
4209 N 18TH E, MOUNTAIN HOME, ID 83647-5899
(208) 599-0944
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
A0003962
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0003962
—
ID
Enumeration date
07/15/2020
Last updated
07/15/2020
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