Provider Demographics
NPI:1104992338
Name:BUOSCIO, RONALD M
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:M
Last Name:BUOSCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 S SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7099
Mailing Address - Country:US
Mailing Address - Phone:815-464-2285
Mailing Address - Fax:480-820-0462
Practice Address - Street 1:19900 80TH AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-3631
Practice Address - Country:US
Practice Address - Phone:815-464-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002355235Z00000X
AZSLP1240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1104992338Medicaid