Healthcare Provider Details

I. General information

NPI: 1457243099
Provider Name (Legal Business Name): KIRSTIE RUHLAND CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ATLANTIC AVE APT 900
LONG BEACH CA
90802-5150
US

IV. Provider business mailing address

604 LOCUST ST APT 1909
DES MOINES IA
50309-3431
US

V. Phone/Fax

Practice location:
  • Phone: 310-704-1891
  • Fax:
Mailing address:
  • Phone: 301-704-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number115659
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26757
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50143
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: