Healthcare Provider Details

I. General information

NPI: 1063785129
Provider Name (Legal Business Name): ALLISON LENN RUGANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SHAMROCK DR SUITE 100-102
EVANSVILLE IN
47715-7325
US

IV. Provider business mailing address

4900 SHAMROCK DR SUITE 100-102
EVANSVILLE IN
47715-7325
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-3494
  • Fax: 812-475-3494
Mailing address:
  • Phone: 812-475-3494
  • Fax: 812-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: