MEDICARE: MS. THERESA ANN RUELLE LMSW

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
1	1041C0700X	Clinical Social Worker	6801084321	MI

General Provider Information

NPI Number	:	1821299769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA ANN RUELLE LMSW

Provider Business Mailing Address
First Line	:	8744 OAK AVE
Second Line	:
City	:	PARIS
State	:	MI
Zip	:	49338-9619
Country	:	US
Telephone Number	:	231-796-5450
Fax Number	:	231-796-5450

Provider Business Practice Location Address
First Line	:	18554 NORTHLAND DR
Second Line	:
City	:	BIG RAPIDS
State	:	MI
Zip	:	49307-8788
Country	:	US
Telephone Number	:	231-250-4335
Fax Number	:	231-796-5450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	09/17/2010

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