Marshall Ruddy – Speech-Language Pathologist

Key facts

NPI: 1982385282
Entity type: Individual (NPI type 1)
Primary specialty: Speech-Language Pathologist 235Z00000X
Practice address: 310 S Main St Ste D
Lombard, IL 60148-2692
Phone: (630) 652-0200
NPI assigned: Jul 28, 2023
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Center for Speech and Language Disorders Speech-Language Pathologist · Elmhurst, IL · NPI 1477602548

NPD (past) SPEECH-LANGUAGE PATHOLOGIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Center for Speech and Language Disorders	Speech-Language Pathologist	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Speech-Language Pathologist	235Z00000X		IL	Yes

Addresses

Primary practice location

310 S Main St Ste D
Lombard, IL 60148-2692

Mailing address

310 S Main St Ste D
Lombard, IL 60148-2692

Other identifiers

Identifier	Type	State	Issuer
1477602548	Medicaid	IL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 8, 2024.

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1982385282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S MAIN ST STE D",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S MAIN ST STE D",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482692",
            "telephone_number": "630-652-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDY",
        "first_name": "MARSHALL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-28",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477602548",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lombard, IL

All providers in Lombard, IL · Speech-Language Pathologist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.