1386217313 NPI number — MRS. LEAH JEAN RUTKOWSKI MA, LPC, MBC-HWC

Table of content: MRS. LEAH JEAN RUTKOWSKI MA, LPC, MBC-HWC (NPI 1386217313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386217313 NPI number — MRS. LEAH JEAN RUTKOWSKI MA, LPC, MBC-HWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTKOWSKI
Provider First Name:
LEAH
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, MBC-HWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386217313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
429 N MCEWAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48617-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-317-8668
Provider Business Mailing Address Fax Number:
989-355-0734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 S MISSION ST STE 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-317-8668
Provider Business Practice Location Address Fax Number:
989-355-0734
Provider Enumeration Date:
07/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6401014255 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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