Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801092648 | MI |
NPI | 1003158882 |
---|---|
Provider Name | Rhonda Marie Rutan |
First Address | Holland, MI 49424-8613 |
Second Address | Holland, MI 49424-8613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 20/03/2013 |