MEDICARE: CASSANDRA LEE RUIZ MS,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	106483	TX
2	235Z00000X	Speech-Language Pathologist	25241	CA

General Provider Information

NPI Number	:	1063860815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA LEE RUIZ MS,CCC-SLP

Provider Business Mailing Address
First Line	:	200 W WILSON AVE UNIT 2625
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1877
Country	:	US
Telephone Number	:	469-223-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 LEMON AVE
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1305
Country	:	US
Telephone Number	:	469-223-9645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	07/27/2021

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Directions to “ CASSANDRA LEE RUIZ MS,CCC-SLP” Practice Location

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