Active NPI
Ivory Rodriguez
- Behavior Technician
- Waconia, MN
National Provider Identifier
1053157883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 138 Stacy Cir
Waconia, MN 55387-9722 - Phone
- (952) 213-1541
- NPI assigned
- Jul 2, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
138 Stacy Cir
Waconia, MN 55387-9722
Mailing address
138 Stacy Cir
Waconia, MN 55387-9722
Other practice location 1
1309 Oak Ave Ste 205
Waconia, MN 55387-1080
Phone (952) 213-1541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1053157883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 STACY CIR",
"city": "WACONIA",
"state": "MN",
"postal_code": "553879722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 STACY CIR",
"city": "WACONIA",
"state": "MN",
"postal_code": "553879722",
"telephone_number": "952-213-1541"
}
],
"practiceLocations": [
{
"address_1": "1309 Oak Ave Ste 205",
"address_purpose": "LOCATION",
"city": "Waconia",
"state": "MN",
"postal_code": "553871080",
"country_code": "US",
"telephone_number": "952-213-1541",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "IVORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-02",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.