Individual
JACKIE RUTIGLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3830 S CUSHMAN ST, FAIRBANKS, AK 99701-7530
(907) 452-1575
Mailing address
3830 S CUSHMAN ST, FAIRBANKS, AK 99701-7530
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH0157
—
AK
Enumeration date
09/14/2012
Last updated
09/14/2012
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