Provider Demographics
NPI:1821775081
Name:RUSK, SOPHIA NICOLE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:NICOLE
Last Name:RUSK
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 1:4741 CAUGHLIN PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0983
Mailing Address - Country:US
Mailing Address - Phone:775-376-1934
Mailing Address - Fax:
Practice Address - Street 1:4741 CAUGHLIN PKWY STE 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0983
Practice Address - Country:US
Practice Address - Phone:775-376-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP3639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist