Organization
JACQUE RUCH LCSW, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISSY L WILSON (OFFICE MANAGER)
(815) 621-1932
Entity
Organization
Contact information
Practice address
650 N MAIN ST, ROCKFORD, IL 61103-6921
(815) 243-8332
(847) 693-3099
Mailing address
650 N MAIN ST, ROCKFORD, IL 61103-6921
(815) 243-8332
(847) 693-3099
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
149015073
IL
Other
Enumeration date
02/11/2017
Last updated
02/11/2017
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