Provider Demographics
NPI:1063860815
Name:RUIZ, CASSANDRA LEE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W WILSON AVE UNIT 2625
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1877
Mailing Address - Country:US
Mailing Address - Phone:469-223-9645
Mailing Address - Fax:
Practice Address - Street 1:9501 LEMON AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1305
Practice Address - Country:US
Practice Address - Phone:469-223-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106483235Z00000X
CA25241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist