Provider Demographics
NPI:1477033439
Name:RUIZ, CYNTHIA A (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CARNABY CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8835
Mailing Address - Country:US
Mailing Address - Phone:317-488-8477
Mailing Address - Fax:
Practice Address - Street 1:4904 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9737
Practice Address - Country:US
Practice Address - Phone:317-885-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003657A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist