Provider Demographics
NPI:1538756135
Name:RUGGLES, JESSE MICHELLE (HIS)
Entity type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:MICHELLE
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 CHENEY DR W STE 130
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4099
Mailing Address - Country:US
Mailing Address - Phone:208-404-6764
Mailing Address - Fax:208-735-1523
Practice Address - Street 1:452 CHENEY DR W STE 130
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4099
Practice Address - Country:US
Practice Address - Phone:208-404-6764
Practice Address - Fax:208-735-1523
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-4207237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist