Provider Demographics
NPI:1043418577
Name:RUCK, ALISE (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:ALISE
Middle Name:
Last Name:RUCK
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5708
Mailing Address - Country:US
Mailing Address - Phone:610-446-1083
Mailing Address - Fax:
Practice Address - Street 1:204 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5708
Practice Address - Country:US
Practice Address - Phone:610-446-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005855231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist