Provider Demographics
NPI:1487686135
Name:RUBLE, MARILOU G (MS AUD)
Entity type:Individual
Prefix:
First Name:MARILOU
Middle Name:G
Last Name:RUBLE
Suffix:
Gender:F
Credentials:MS AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2272
Mailing Address - Country:US
Mailing Address - Phone:419-905-7037
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:419-905-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001082A231H00000X
TNA0000001464231H00000X
PAAT006243231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1138236OtherWINDSOR MEDICARE ADVANTAGE
TN4166173OtherBLUE CROSS/BLUE SHIELD
9277081OtherAETNA
TN3192016Medicaid
9368045OtherCIGNA
TN10032658OtherSIGNATURE HEALTH ALLIANCE
TN3192016Medicaid
3192016Medicare PIN