Healthcare Provider Details

I. General information

NPI: 1336757210
Provider Name (Legal Business Name): HAILEY MARIE RUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33464 SCHOENHERR RD STE 180
STERLING HEIGHTS MI
48312-6392
US

IV. Provider business mailing address

39920 E RIVER CT
CLINTON TWP MI
48038-3008
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-4792
  • Fax:
Mailing address:
  • Phone: 586-404-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: