MEDICARE: MRS. SUZANNA KING RUSKUSKY 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	146.010931	IL

General Provider Information

NPI Number	:	1609117415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNA KING RUSKUSKY MS CCC-SLP

Provider Business Mailing Address
First Line	:	1747 W FLETCHER ST
Second Line	:	APARTMENT #1
City	:	CHICAGO
State	:	IL
Zip	:	60657-3023
Country	:	US
Telephone Number	:	773-484-7679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 W FLETCHER ST
Second Line	:	APARTMENT #1
City	:	CHICAGO
State	:	IL
Zip	:	60657-3023
Country	:	US
Telephone Number	:	773-484-7679
Fax Number	:

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

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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