Provider Demographics
NPI:1760514418
Name:RUSHKEWICZ, MARY ANN
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:RUSHKEWICZ
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 1:3S190 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1519
Mailing Address - Country:US
Mailing Address - Phone:630-393-9038
Mailing Address - Fax:630-393-9038
Practice Address - Street 1:3S190 HARVEST CT
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1519
Practice Address - Country:US
Practice Address - Phone:630-393-9038
Practice Address - Fax:630-393-9038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist