Provider Demographics
NPI:1700969623
Name:JOHNS, RUTHIE B (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RUTHIE
Middle Name:B
Last Name:JOHNS
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 1:1466 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4329
Mailing Address - Country:US
Mailing Address - Phone:407-810-6851
Mailing Address - Fax:
Practice Address - Street 1:1466 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4329
Practice Address - Country:US
Practice Address - Phone:407-810-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885298700Medicaid