Provider Demographics
NPI:1093207441
Name:RUZICKA, TAMYRA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:L
Last Name:RUZICKA
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 1:6104 E ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5917
Mailing Address - Country:US
Mailing Address - Phone:480-440-2231
Mailing Address - Fax:
Practice Address - Street 1:7550 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4618
Practice Address - Country:US
Practice Address - Phone:602-371-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist