Provider Demographics
NPI:1255467569
Name:RUFFING, RACHELLE (MSCCC SLP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:RUFFING
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 S 18TH E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-5846
Mailing Address - Country:US
Mailing Address - Phone:208-599-2536
Mailing Address - Fax:208-587-5734
Practice Address - Street 1:245 N 3RD E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2734
Practice Address - Country:US
Practice Address - Phone:208-599-2536
Practice Address - Fax:208-587-5734
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist