Healthcare Provider Details

I. General information

NPI: 1558409268
Provider Name (Legal Business Name): DANA ELIZABETH RUSCHE M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WALLINGWOOD DR BLDG 2
AUSTIN TX
78746-6900
US

IV. Provider business mailing address

2525 WALLINGWOOD DR BLDG 2
AUSTIN TX
78746-6900
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-6179
  • Fax: 512-327-1545
Mailing address:
  • Phone: 512-327-6179
  • Fax: 512-327-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103110
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: