MEDICARE: MICHELL RUSKAMP M.S. 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	1265	NE

General Provider Information

NPI Number	:	1578709218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELL RUSKAMP M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	3661 C RD
Second Line	:
City	:	RISING CITY
State	:	NE
Zip	:	68658-3791
Country	:	US
Telephone Number	:	402-542-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 C RD
Second Line	:
City	:	RISING CITY
State	:	NE
Zip	:	68658-3791
Country	:	US
Telephone Number	:	402-542-2313
Fax Number	:

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

Provider Enumeration Date	:	12/31/2008
Last Update Date	:	12/31/2008

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Directions to “ MICHELL RUSKAMP M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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