Individual
AMBER J RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7550
Mailing address
2986 PEBBLE CREEK ST, MELBOURNE, FL 32935-7157
(307) 631-1907
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
135
WY
1041C0700X
Clinical Social Worker
413
WY
1041C0700X
Clinical Social Worker
Primary
789
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106079100
—
WY
Enumeration date
10/14/2009
Last updated
04/16/2024
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