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General NPI Number Information
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NPI Number | 1720199045
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Entity Type | Individual
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Provider Name | SANDRA L RUEN MSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 2805 FAIRFIELD AVE C/O TAMARA ROLLER
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City | FORT WAYNE
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State | IN
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Zip | 46807-1218
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Country | US
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Telephone | 260-456-4880
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Fax | 260-456-3559
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Provider Business Mailing Address
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Address Line | 2805 FAIRFIELD AVE C/O TAMARA ROLLER
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City | FORT WAYNE
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State | IN
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Zip | 46807-1218
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Country | US
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Telephone | 260-456-4880
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Fax | 260-456-3559
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 34000946A
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License Number State | IN
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