Provider Demographics
NPI:1073969549
Name:RUTKOWSKI, ANNESSA
Entity Type:Individual
Prefix:
First Name:ANNESSA
Middle Name:
Last Name:RUTKOWSKI
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 1:7130 HODGSON MEMORIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1526
Mailing Address - Country:US
Mailing Address - Phone:912-355-3392
Mailing Address - Fax:912-355-3372
Practice Address - Street 1:7130 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1526
Practice Address - Country:US
Practice Address - Phone:912-355-3392
Practice Address - Fax:912-355-3372
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist