Provider Demographics
NPI:1013436526
Name:RUHOLL, NATASHA RENEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:RENEE
Last Name:RUHOLL
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 1:16136 E 1485TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-3405
Mailing Address - Country:US
Mailing Address - Phone:217-343-1617
Mailing Address - Fax:833-799-0369
Practice Address - Street 1:16136 E 1485TH AVE
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-3405
Practice Address - Country:US
Practice Address - Phone:217-343-1617
Practice Address - Fax:833-799-0369
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist