Provider Demographics
NPI:1427757327
Name:RUZICKA LOPEZ, MARISSA QUINN
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:QUINN
Last Name:RUZICKA LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1476
Mailing Address - Country:US
Mailing Address - Phone:509-200-1580
Mailing Address - Fax:
Practice Address - Street 1:31 SE ASH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1187
Practice Address - Country:US
Practice Address - Phone:509-525-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant