Provider Demographics
NPI:1356626790
Name:SUCKOW, RUTH S (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:S
Last Name:SUCKOW
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:S
Other - Last Name:DEMPSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:16 REILLY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-2635
Mailing Address - Country:US
Mailing Address - Phone:845-325-0347
Mailing Address - Fax:
Practice Address - Street 1:25 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2149
Practice Address - Country:US
Practice Address - Phone:845-794-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist