MEDICARE: MS. SPENCER LYNETTE RUACHO 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
1	235Z00000X	Speech-Language Pathologist	SA 6889	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2566	OTHER	FL	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639271364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SPENCER LYNETTE RUACHO CCC-SLP

Provider Business Mailing Address
First Line	:	2642 COLLINS AVE
Second Line	:	#303
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4738
Country	:	US
Telephone Number	:	305-785-7484
Fax Number	:	305-531-5016

Provider Business Practice Location Address
First Line	:	2642 COLLINS AVE
Second Line	:	#303
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4738
Country	:	US
Telephone Number	:	305-785-7484
Fax Number	:	305-531-5016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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