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General NPI Number Information
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NPI Number | 1639577943
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Entity Type | Individual
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Provider Name | SANDRA RUGGLES LCPC
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Gender | Female
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 770 LAKE COOK RD SUITE 220
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City | DEERFIELD
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State | IL
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Zip | 60015
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Country | US
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Telephone | 866-220-8371
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 HENRY ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081
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Country | US
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Telephone | 847-284-4001
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180006623
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006623
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License Number State | IL
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