Provider Demographics
NPI:1043854672
Name:RUGGIERI, JILL DETWEILER
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DETWEILER
Last Name:RUGGIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 VAUCLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1215
Mailing Address - Country:US
Mailing Address - Phone:610-506-1317
Mailing Address - Fax:
Practice Address - Street 1:1024 VAUCLAIN AVE
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1215
Practice Address - Country:US
Practice Address - Phone:610-506-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist