Provider Demographics
NPI:1063189595
Name:MASKE, RUDI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RUDI
Middle Name:
Last Name:MASKE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:RUDI
Other - Middle Name:
Other - Last Name:VENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-2064
Mailing Address - Country:US
Mailing Address - Phone:605-261-6663
Mailing Address - Fax:
Practice Address - Street 1:2400 S BAHNSON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4462
Practice Address - Country:US
Practice Address - Phone:605-371-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD967-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist