=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487284964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA JOANNA RUEGG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2020
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 N MAIN ST
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-682-1551
-----------------------------------------------------
Fax | 828-675-9312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 MCDOWELL RIDGE RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-675-2767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 12855
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------