Provider Demographics
NPI:1831304773
Name:RUZICH, SHAUNA J (SLP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:J
Last Name:RUZICH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:J
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1611 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7647
Mailing Address - Country:US
Mailing Address - Phone:815-319-8595
Mailing Address - Fax:855-837-4651
Practice Address - Street 1:2501 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3733
Practice Address - Country:US
Practice Address - Phone:217-239-2849
Practice Address - Fax:217-356-7964
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IN22003708A235Z00000X
IL146006731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist