Provider Demographics
NPI:1083776751
Name:RUTHENBECK, LYNN (SP7201)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:RUTHENBECK
Suffix:
Gender:F
Credentials:SP7201
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15302 KNOLLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2753
Mailing Address - Country:US
Mailing Address - Phone:949-599-0218
Mailing Address - Fax:949-859-0928
Practice Address - Street 1:4811 EUREKA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3368
Practice Address - Country:US
Practice Address - Phone:949-599-0218
Practice Address - Fax:949-859-0928
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist