Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 01520 | IA |
Y | 103TC0700X | Clinical Psychologist | 01520 | IA |
NPI | 1003881160 |
---|---|
Provider Name | Adrianna Ruisch |
First Address | Le Mars, IA 51031-2500 |
Second Address | Le Mars, IA 51031-2550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |