Provider Demographics
NPI:1821307737
Name:KOGEL, RUTH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:KOGEL
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:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-0043
Mailing Address - Country:US
Mailing Address - Phone:631-821-0210
Mailing Address - Fax:631-821-0210
Practice Address - Street 1:230 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2944
Practice Address - Country:US
Practice Address - Phone:631-874-1296
Practice Address - Fax:631-874-1296
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015092-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist