MEDICARE: MS. RUTH ANN HACKENBRACHT 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	LL00002761	WA

General Provider Information

NPI Number	:	1770547283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH ANN HACKENBRACHT SLP

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-8901
Country	:	US
Telephone Number	:	360-794-1061
Fax Number	:	866-611-1620

Provider Business Practice Location Address
First Line	:	13507 327TH CT SE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-8722
Country	:	US
Telephone Number	:	425-890-5148
Fax Number	:	425-654-0562

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/02/2021

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