MEDICARE: NICOLE MARIE RUSCHE 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	2804-154	WI

General Provider Information

NPI Number	:	1619025483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE RUSCHE CCC-SLP

Provider Business Mailing Address
First Line	:	3022 EDENSWAY RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1565
Country	:	US
Telephone Number	:	608-345-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2514 S 102ND ST STE 150
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-2142
Country	:	US
Telephone Number	:	866-458-2337
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	06/15/2009

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Directions to “ NICOLE MARIE RUSCHE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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