Provider Demographics
NPI:1073026712
Name:RUFFNER, LAURA ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:RUFFNER
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 1:5494 BLACKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1708
Mailing Address - Country:US
Mailing Address - Phone:815-978-7663
Mailing Address - Fax:
Practice Address - Street 1:5494 BLACKTHORN DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1708
Practice Address - Country:US
Practice Address - Phone:815-978-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist