=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639319130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARALYN RUBSAM M.A., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2009
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1760 ABBEY RD STE 202
-----------------------------------------------------
City | EAST LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48823-7395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-225-4525
-----------------------------------------------------
Fax | 517-225-6844
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1760 ABBEY RD STE 202
-----------------------------------------------------
City | EAST LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48823-7395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-225-4525
-----------------------------------------------------
Fax | 517-225-6844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 12045689
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 7101000151
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------