Provider Demographics
NPI:1972709202
Name:RUGGIERO, ALISA LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LYNN
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9772
Mailing Address - Country:US
Mailing Address - Phone:860-413-9157
Mailing Address - Fax:
Practice Address - Street 1:14 SENECA DR
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9772
Practice Address - Country:US
Practice Address - Phone:860-413-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist