MEDICARE: LYNN RUTHENBECK SP7201

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	SP7201	CA

General Provider Information

NPI Number	:	1083776751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN RUTHENBECK SP7201

Provider Business Mailing Address
First Line	:	15302 KNOLLWOOD CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2753
Country	:	US
Telephone Number	:	949-599-0218
Fax Number	:	949-859-0928

Provider Business Practice Location Address
First Line	:	4811 EUREKA AVE
Second Line	:	SUITE A
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3368
Country	:	US
Telephone Number	:	949-599-0218
Fax Number	:	949-859-0928

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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