Provider Demographics
NPI:1023150554
Name:RUIZ, ALICE GISELLE (MA)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:GISELLE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CITRUS TOWER BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1907
Mailing Address - Country:US
Mailing Address - Phone:352-256-7295
Mailing Address - Fax:
Practice Address - Street 1:245 CITRUS TOWER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1907
Practice Address - Country:US
Practice Address - Phone:352-256-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist