Provider Demographics
NPI:1215186937
Name:RUFFIN, GRETA (MS)
Entity Type:Individual
Prefix:MS
First Name:GRETA
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6252 186TH PL NE APT 106
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0537
Mailing Address - Country:US
Mailing Address - Phone:425-836-5098
Mailing Address - Fax:425-836-5098
Practice Address - Street 1:6252 186TH PL NE APT 106
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0537
Practice Address - Country:US
Practice Address - Phone:425-836-5098
Practice Address - Fax:425-836-5098
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL00003900OtherSTATE OF WASHINGTON HEALTH PROFESSIONS QUALITY ASSURANCE DIVISION/SLP