Provider Demographics
NPI:1033099585
Name:RUDEEN, TENILLE (SLP)
Entity type:Individual
Prefix:
First Name:TENILLE
Middle Name:
Last Name:RUDEEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13413 N MOONGLOW LN
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5122
Mailing Address - Country:US
Mailing Address - Phone:208-242-7377
Mailing Address - Fax:208-417-0956
Practice Address - Street 1:611 WILSON AVE STE 3
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5046
Practice Address - Country:US
Practice Address - Phone:208-242-7377
Practice Address - Fax:208-417-0956
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7771272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist