Provider Demographics
NPI:1639271364
Name:RUACHO, SPENCER LYNETTE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SPENCER
Middle Name:LYNETTE
Last Name:RUACHO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 COLLINS AVE
Mailing Address - Street 2:#303
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4738
Mailing Address - Country:US
Mailing Address - Phone:305-785-7484
Mailing Address - Fax:305-531-5016
Practice Address - Street 1:2642 COLLINS AVE
Practice Address - Street 2:#303
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4738
Practice Address - Country:US
Practice Address - Phone:305-785-7484
Practice Address - Fax:305-531-5016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2566OtherBLUECROSS BLUESHIELD