Provider Demographics
NPI:1306259155
Name:RUBIN, GENEVIEVE LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:LAUREN
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 ROWNTREE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2760
Mailing Address - Country:US
Mailing Address - Phone:815-262-8777
Mailing Address - Fax:
Practice Address - Street 1:1957 W DICKENS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3934
Practice Address - Country:US
Practice Address - Phone:773-789-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist