Healthcare Provider Details

I. General information

NPI: 1083012041
Provider Name (Legal Business Name): SARAH RUZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 10/11/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST
NEENAH WI
54956-2883
US

IV. Provider business mailing address

130 2ND ST
NEENAH WI
54956-2883
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-2155
  • Fax: 920-729-7350
Mailing address:
  • Phone: 920-729-2155
  • Fax: 920-720-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003859
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4593-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: