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NPI Code Detail

MEDICARE: RONALD LEE DUDASH MSCCCSLP

MEDICARE: RONALD LEE DUDASH MSCCCSLP
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 Pathologist1402-154WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21402-154OTHERWISPEECH LANGAGE PATHOLOGY LICENSE

General Provider Information

NPI Number : 1962678508
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD LEE DUDASH MSCCCSLP
Provider Business Mailing Address
First Line : 19 W NEWTON ST
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-1744
Country : US
Telephone Number : 715-234-2161
Fax Number :
Provider Business Practice Location Address
First Line : 19 W NEWTON ST
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-1744
Country : US
Telephone Number : 715-234-2161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2008
Last Update Date : 05/04/2008

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