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General NPI Number Information
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NPI Number | 1407129471
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Entity Type | Individual
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Provider Name | JACQUELYN J RUCH LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 05/10/2020
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Provider Practice Location Address
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Address Line | 3205 SOUTHGATE CIR STE 19
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City | SARASOTA
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State | FL
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Zip | 34239-5514
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Country | US
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Telephone | 815-243-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 11519 SWEETGRASS DR
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City | BRADENTON
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State | FL
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Zip | 34212-2522
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Country | US
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Telephone | 815-243-8332
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015073
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15770
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License Number State | FL
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