Basic Information
| Provider Information | |||||||||
| NPI: | 1952646945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSCH | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 438 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640931925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607477823 | ||||||||
| FaxNumber: | 6607479615 | ||||||||
| Practice Location | |||||||||
| Address1: | 438 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640931925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607477823 | ||||||||
| FaxNumber: | 6607479615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2005004545 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.