MEDICARE: DR. PAMELA RUFFER, P.C.

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	103TC0700X	Clinical Psychologist	071007701	IL

General Provider Information

NPI Number	:	1891132130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. PAMELA RUFFER, P.C.

Provider Business Mailing Address
First Line	:	200 E EVERGREEN AVE
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3240
Country	:	US
Telephone Number	:	630-539-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E EVERGREEN AVE
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3240
Country	:	US
Telephone Number	:	630-539-0217
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. PAMELA RUFFER
Credential	:	PSY.D.
Telephone Number	:	630-539-0217

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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