MEDICARE: RUTH ELAINE VAN HASSELT 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	SC 85729	CA

General Provider Information

NPI Number	:	1790107415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELAINE VAN HASSELT SLP

Provider Business Mailing Address
First Line	:	2119 VALLEY RIM GLN
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-3839
Country	:	US
Telephone Number	:	760-290-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 VALLEY RIM GLN
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-3839
Country	:	US
Telephone Number	:	760-290-3530
Fax Number	:

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

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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