Provider Demographics
NPI:1457830499
Name:RUBLE, CYNTHIA ELGIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELGIE
Last Name:RUBLE
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W WACKERLY ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7264
Mailing Address - Country:US
Mailing Address - Phone:989-832-4220
Mailing Address - Fax:989-832-4207
Practice Address - Street 1:304 W WACKERLY ST STE 500
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7264
Practice Address - Country:US
Practice Address - Phone:989-832-4220
Practice Address - Fax:989-832-4207
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist