Healthcare Provider Details

I. General information

NPI: 1447878871
Provider Name (Legal Business Name): LIA RUGGERIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 THOMPSON ST
JERSEY SHORE PA
17740-1729
US

IV. Provider business mailing address

1020 THOMPSON ST
JERSEY SHORE PA
17740-1729
US

V. Phone/Fax

Practice location:
  • Phone: 570-398-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: