Provider Demographics
NPI:1497094734
Name:RUGGLES, JUSTEEN L
Entity Type:Individual
Prefix:
First Name:JUSTEEN
Middle Name:L
Last Name:RUGGLES
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 1:201 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2513
Mailing Address - Country:US
Mailing Address - Phone:816-521-5300
Mailing Address - Fax:
Practice Address - Street 1:201 N FOREST AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2513
Practice Address - Country:US
Practice Address - Phone:816-521-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012039490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist