Provider Demographics
NPI:1447445093
Name:RUDA, AMANDA KAY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:RUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:HOLCOMB
Mailing Address - State:KS
Mailing Address - Zip Code:67851-0155
Mailing Address - Country:US
Mailing Address - Phone:620-277-0013
Mailing Address - Fax:
Practice Address - Street 1:100 PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:HOLCOMB
Practice Address - State:KS
Practice Address - Zip Code:67851-9747
Practice Address - Country:US
Practice Address - Phone:620-277-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist