Provider Demographics
NPI:1740564384
Name:RYVKIN, VLADISLAVA (MS, SLP)
Entity Type:Individual
Prefix:
First Name:VLADISLAVA
Middle Name:
Last Name:RYVKIN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 POST ST
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3441
Mailing Address - Country:US
Mailing Address - Phone:415-310-8611
Mailing Address - Fax:415-661-3490
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:SUITE # 307
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3441
Practice Address - Country:US
Practice Address - Phone:415-310-8611
Practice Address - Fax:415-661-3490
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist