MEDICARE: MIKKI RUIZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1447696695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKKI RUIZ MSW

Provider Business Mailing Address
First Line	:	113 LINCOLNWAY E
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46544-2016
Country	:	US
Telephone Number	:	574-255-4976
Fax Number	:	574-255-1882

Provider Business Practice Location Address
First Line	:	2809 GREENWOOD AVE
Second Line	:
City	:	TRAIL CREEK
State	:	IN
Zip	:	46360-5709
Country	:	US
Telephone Number	:	574-361-3979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	08/11/2022

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