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General NPI Number Information
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NPI Number | 1306101324
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Entity Type | Individual
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Provider Name | SUZANNE RUCKER SUZANNE RUCKER MS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 182 W SR 434 STE 1016
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City | LONGWOOD
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State | FL
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Zip | 32750-5180
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Country | US
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Telephone | 407-967-9313
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Fax | 407-804-9378
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Provider Business Mailing Address
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Address Line | 182 W SR 434 STE 1016
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City | LONGWOOD
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State | FL
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Zip | 32750-5180
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Country | US
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Telephone | 407-967-9313
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Fax | 407-804-9378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH8733
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License Number State | FL
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