Doctor Name: | JENNA ANN RUBACK |
NPI Number: | 1275968711 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SP19600 |
Business Practice Address: | 11301 Wilshire Blvd Audiology & Speech Pathology Service (126) Los Angeles, CA - 900731003 |
Business Phone Number: | 3102683701 |
Business Fax Number: | 3102684791 |
Mailing Address: | 11301 Wilshire Blvd, Audiology & Speech Pathology Service (126) LOS ANGELES |
State: | CA |
Postal Code: | 900731003 |
Phone Number: | 3102683701 |
Fax Number: | 3102684791 |
NPI Enumeration Date: | 09/03/2013 |
NPI Last Update Date: | 09/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP19600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |