Provider Demographics
NPI:1942757190
Name:CHIKUKU, RUTENDO
Entity Type:Individual
Prefix:
First Name:RUTENDO
Middle Name:
Last Name:CHIKUKU
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 1:1415 S HAWTHORNE DR
Mailing Address - Street 2:304
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9310
Mailing Address - Country:US
Mailing Address - Phone:314-552-1143
Mailing Address - Fax:
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:601
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-334-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60689115231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist