Provider Demographics
NPI:1811169055
Name:RUDEN, ANNE ELIZABETH (MSCCC/SLP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:RUDEN
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 SW CENTURY DR
Mailing Address - Street 2:#57
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8674
Mailing Address - Country:US
Mailing Address - Phone:971-241-2693
Mailing Address - Fax:
Practice Address - Street 1:16100 SW CENTURY DR
Practice Address - Street 2:#57
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8674
Practice Address - Country:US
Practice Address - Phone:971-241-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278549Medicaid