Provider Demographics
NPI:1578852091
Name:RUPP, JANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:RUPP
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 1:7444 DALLAS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7770
Mailing Address - Country:US
Mailing Address - Phone:512-431-7331
Mailing Address - Fax:
Practice Address - Street 1:3200 STECK AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8000
Practice Address - Country:US
Practice Address - Phone:512-431-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist