Provider Demographics
NPI:1205971926
Name:RUCKEL, JOANN CAVASENO (SLP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:CAVASENO
Last Name:RUCKEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3507
Mailing Address - Country:US
Mailing Address - Phone:631-744-7327
Mailing Address - Fax:631-209-0857
Practice Address - Street 1:250 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3507
Practice Address - Country:US
Practice Address - Phone:631-744-7327
Practice Address - Fax:631-209-0857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010051-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist