Provider Demographics
NPI:1447520630
Name:RUPP, SHARLEEN MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:SHARLEEN
Middle Name:MARIE
Last Name:RUPP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MRS
Other - First Name:SHARLEEN
Other - Middle Name:MARIE
Other - Last Name:MORNINGSTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:GEORGIA AVENUE, BLDG 3508
Mailing Address - Street 2:
Mailing Address - City:FT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:337-531-3192
Mailing Address - Fax:337-531-4196
Practice Address - Street 1:5979 DESERT STORM AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5514
Practice Address - Country:US
Practice Address - Phone:270-412-9110
Practice Address - Fax:270-412-9131
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD392A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist