MEDICARE: REBECCA RUGGLESS SLPA

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	2355S0801X	Speech-Language Assistant	2733	CA

General Provider Information

NPI Number	:	1538732458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RUGGLESS SLPA

Provider Business Mailing Address
First Line	:	18139 ERIK CT UNIT 256
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91387-4990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2656
Country	:	US
Telephone Number	:	818-568-7925
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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Directions to “ REBECCA RUGGLESS SLPA” Practice Location

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