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General NPI Number Information
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NPI Number | 1366757569
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Entity Type | Individual
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Provider Name | BARBARA R RUCKER SAC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 74 ECLIPSE CTR
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City | BELOIT
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State | WI
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Zip | 53511-3550
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Country | US
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Telephone | 608-313-3120
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Fax | 608-361-0312
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Provider Business Mailing Address
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Address Line | 74 ECLIPSE CTR
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City | BELOIT
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State | WI
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Zip | 53511-3550
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Country | US
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Telephone | 608-313-3120
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Fax | 608-361-0312
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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