Provider Demographics
NPI:1043596851
Name:RUIZ, JEANETTE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 VIOLA ST
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4414
Mailing Address - Country:US
Mailing Address - Phone:845-895-7225
Mailing Address - Fax:
Practice Address - Street 1:137 VIOLA ST
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4414
Practice Address - Country:US
Practice Address - Phone:845-895-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist