Provider Demographics
NPI:1588972236
Name:RUSKA, SUZANNE (MS/CCC/SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:RUSKA
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:LEBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC/SLP
Mailing Address - Street 1:3233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1323
Mailing Address - Country:US
Mailing Address - Phone:716-833-5353
Mailing Address - Fax:716-833-0108
Practice Address - Street 1:3233 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1323
Practice Address - Country:US
Practice Address - Phone:716-833-5353
Practice Address - Fax:716-833-0108
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002489-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist