Provider Demographics
NPI:1174724272
Name:RUCKMAN, JILL MICHELLE (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MICHELLE
Last Name:RUCKMAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DOVE TRL
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77531-2249
Mailing Address - Country:US
Mailing Address - Phone:281-685-2323
Mailing Address - Fax:
Practice Address - Street 1:2743 IMPERIA DR STE 103
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8988
Practice Address - Country:US
Practice Address - Phone:281-616-3839
Practice Address - Fax:346-299-5196
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist