Provider Demographics
NPI:1003206798
Name:RUTAS, KRISTINA NICHOLE (MA, BS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NICHOLE
Last Name:RUTAS
Suffix:
Gender:F
Credentials:MA, BS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 GREENWAY TRL APT 2D
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1653
Mailing Address - Country:US
Mailing Address - Phone:630-506-0426
Mailing Address - Fax:
Practice Address - Street 1:66 MILLER DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5144
Practice Address - Country:US
Practice Address - Phone:630-907-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist