Provider Demographics
NPI:1417113879
Name:RUHL, MARISSA LYNN
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LYNN
Last Name:RUHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 S CONFERENCE DR APT A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3113
Mailing Address - Country:US
Mailing Address - Phone:305-772-8034
Mailing Address - Fax:
Practice Address - Street 1:2098 S CONFERENCE DR APT A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3113
Practice Address - Country:US
Practice Address - Phone:305-772-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist