Provider Demographics
NPI:1588677579
Name:RUZICKA, MARIE (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:RUZICKA
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 DEEP WATER LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8504
Mailing Address - Country:US
Mailing Address - Phone:630-305-0593
Mailing Address - Fax:630-305-0683
Practice Address - Street 1:2156 DEEP WATER LN
Practice Address - Street 2:STE 110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8507
Practice Address - Country:US
Practice Address - Phone:630-904-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002227448OtherBLUE CROSS BLUE SHIELD