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General NPI Number Information
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NPI Number | 1659523843
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Entity Type | Individual
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Provider Name | CASEY NICOLE RUGGIERO PHD
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 210 N HIGGINS AVE # 324
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City | MISSOULA
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State | MT
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Zip | 59802-4462
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Country | US
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Telephone | 406-360-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 RAINIER WAY
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City | FLORENCE
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State | MT
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Zip | 59833
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Country | US
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Telephone | 406-360-3184
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-PSY-LIC-1456
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License Number State | MT
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