Provider Demographics
NPI:1881888147
Name:RUTENBERG, KIRSTEN ELIZABETH (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:RUTENBERG
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 NW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3940
Mailing Address - Country:US
Mailing Address - Phone:352-372-0568
Mailing Address - Fax:
Practice Address - Street 1:435 DAUER HALL
Practice Address - Street 2:UNIVERSITY OF FLORIDA
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:352-392-2041
Practice Address - Fax:352-846-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist