Provider Demographics
NPI:1417213620
Name:RUDD, ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RUDD
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 1:2208 CAMINO RAMON STE B
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1328
Mailing Address - Country:US
Mailing Address - Phone:925-362-0683
Mailing Address - Fax:
Practice Address - Street 1:2208 CAMINO RAMON STE B
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1328
Practice Address - Country:US
Practice Address - Phone:925-362-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 7400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist