Provider Demographics
NPI:1235781287
Name:RUGGIERO, ALYSSA SUE (SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SUE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLUB HOUSE CT APT CH9
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-9305
Mailing Address - Country:US
Mailing Address - Phone:570-460-4499
Mailing Address - Fax:
Practice Address - Street 1:105 CLUB HOUSE CT APT CH9
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-9305
Practice Address - Country:US
Practice Address - Phone:570-460-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist