Provider Demographics
NPI:1326630435
Name:RUDERMAN, MARJA JENNIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARJA
Middle Name:JENNIE
Last Name:RUDERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CROWN DR UNIT 307
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5564
Mailing Address - Country:US
Mailing Address - Phone:413-427-6194
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON ST BLDG P
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1740
Practice Address - Country:US
Practice Address - Phone:413-427-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist