Individual
MRS. EVANA RUTH SANDUSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
9689 COUNTY ROAD 975 N, MC LEANSBORO, IL 62859-2089
(618) 967-2113
(618) 643-3916
Mailing address
9689 COUNTY ROAD 975 N, MC LEANSBORO, IL 62859-2089
(618) 967-2113
(618) 643-3916
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.008291
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03332004
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/18/2006
Last updated
05/24/2016
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