Individual
ETHAN RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4875 N PAULINA ST APT 2A, CHICAGO, IL 60640-4176
(904) 599-6248
Mailing address
4875 N PAULINA ST APT 2A, CHICAGO, IL 60640-4176
(904) 599-6248
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178013109
IL
Other
Enumeration date
07/26/2017
Last updated
07/21/2022
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