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NPI Code Detail

MEDICARE: GENEVIEVE LAUREN RUBIN M.S., CCC-SLP

MEDICARE: GENEVIEVE LAUREN RUBIN M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146.011819IL

General Provider Information

NPI Number : 1306259155
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVIEVE LAUREN RUBIN M.S., CCC-SLP
Provider Business Mailing Address
First Line : 1661 ROWNTREE LN
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2760
Country : US
Telephone Number : 815-262-8777
Fax Number :
Provider Business Practice Location Address
First Line : 1957 W DICKENS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-3934
Country : US
Telephone Number : 773-789-9640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 06/10/2014

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Directions to “ GENEVIEVE LAUREN RUBIN M.S., CCC-SLP” Practice Location

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