Provider Demographics
NPI:1962678508
Name:DUDASH, RONALD LEE (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:DUDASH
Suffix:
Gender:M
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1744
Mailing Address - Country:US
Mailing Address - Phone:715-234-2161
Mailing Address - Fax:
Practice Address - Street 1:19 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1744
Practice Address - Country:US
Practice Address - Phone:715-234-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1402-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42788600Medicaid
WI1402-154OtherSPEECH LANGAGE PATHOLOGY LICENSE