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NPI Code Detail

MEDICARE: GRETCHEN RUCKER

MEDICARE: GRETCHEN RUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1316412968
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETCHEN RUCKER
Provider Business Mailing Address
First Line : 5413 E OLD FARM CIR
Second Line :
City : COLO SPGS
State : CO
Zip : 80917-1111
Country : US
Telephone Number : 719-641-3450
Fax Number :
Provider Business Practice Location Address
First Line : 6197 LEHMAN DR STE 102
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3446
Country : US
Telephone Number : 719-266-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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Directions to “ GRETCHEN RUCKER ” Practice Location

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