Provider Demographics
NPI:1629220330
Name:RUBACK, CAROL MASELLI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MASELLI
Last Name:RUBACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NW 99 AVENUE
Mailing Address - Street 2:INNOVATIVE SPEECH & LANGUAGE SERVICES, P.A.
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:954-253-4897
Mailing Address - Fax:954-474-3403
Practice Address - Street 1:1511 NW 99 AVENUE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-253-4897
Practice Address - Fax:954-474-3403
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist