Provider Demographics
NPI:1205095213
Name:LIEVANO, RUTH XIMENA
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:XIMENA
Last Name:LIEVANO
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 1:8 ASSABET XING
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5237
Mailing Address - Country:US
Mailing Address - Phone:978-298-5184
Mailing Address - Fax:
Practice Address - Street 1:785 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3310
Practice Address - Country:US
Practice Address - Phone:978-369-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist