Provider Demographics
NPI:1952780033
Name:QUEZADA, RUTH (SLP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:QUEZADA
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 1:803 COFFEE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4238
Mailing Address - Country:US
Mailing Address - Phone:209-549-7765
Mailing Address - Fax:209-480-6799
Practice Address - Street 1:803 COFFEE RD STE 6
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4238
Practice Address - Country:US
Practice Address - Phone:209-549-7765
Practice Address - Fax:209-480-6799
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist