Healthcare Provider Details

I. General information

NPI: 1760152896
Provider Name (Legal Business Name): JEANNE LOUISE RUGG MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 RUNNING W DR
GILLETTE WY
82718-2074
US

IV. Provider business mailing address

3722 OLD GLORY
GILLETTE WY
82718-8512
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-0669
  • Fax:
Mailing address:
  • Phone: 951-691-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-2259
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: