Provider Demographics
NPI:1467979484
Name:RUEB, SUNITA
Entity Type:Individual
Prefix:
First Name:SUNITA
Middle Name:
Last Name:RUEB
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 1:100 MINER ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60928-8092
Mailing Address - Country:US
Mailing Address - Phone:815-683-2662
Mailing Address - Fax:
Practice Address - Street 1:511 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CISSNA PARK
Practice Address - State:IL
Practice Address - Zip Code:60924-9734
Practice Address - Country:US
Practice Address - Phone:815-457-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-002915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist