Healthcare Provider Details

I. General information

NPI: 1831630201
Provider Name (Legal Business Name): ANDREA RUETTEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2529
US

IV. Provider business mailing address

1427 VALLEY LAKE DR APT 1241
SCHAUMBURG IL
60195-3651
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax:
Mailing address:
  • Phone: 815-757-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: