Healthcare Provider Details

I. General information

NPI: 1043488109
Provider Name (Legal Business Name): JUDITH STEPHANIE RUZUMNA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 PASTOR CT
W BLOOMFIELD MI
48322-1349
US

IV. Provider business mailing address

6555 PASTOR CT
W BLOOMFIELD MI
48322-1349
US

V. Phone/Fax

Practice location:
  • Phone: 248-661-1916
  • Fax:
Mailing address:
  • Phone: 248-661-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301000623
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: