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General NPI Number Information
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NPI Number | 1366059818
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Entity Type | Individual
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Provider Name | AMY D RUCKMAN PEL
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Gender | Female
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 407 S EDWARDS ST
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City | ALTAMONT
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State | IL
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Zip | 62411-1799
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Country | US
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Telephone | 618-483-5171
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Fax | 618-483-6793
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Provider Business Mailing Address
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Address Line | 407 S EDWARDS ST
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City | ALTAMONT
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State | IL
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Zip | 62411-1799
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Country | US
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Telephone | 618-483-5171
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Fax | 618-483-6793
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 448350
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License Number State | IL
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