Healthcare Provider Details

I. General information

NPI: 1114274792
Provider Name (Legal Business Name): JANETTE C. RESSUE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 EXPERIMENTAL STATION RD
PASO ROBLES CA
93446-9307
US

IV. Provider business mailing address

1018 EXPERIMENTAL STATION RD
PASO ROBLES CA
93446-9307
US

V. Phone/Fax

Practice location:
  • Phone: 707-494-6974
  • Fax:
Mailing address:
  • Phone: 707-494-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 11361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: