Individual
LAURIE S. FAIRALL-RUETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4400 MARSH LANDING BLVD, SUITE 1, PONTE VEDRA BEACH, FL 32082-1287
(904) 463-2284
(904) 543-7755
Mailing address
4400 MARSH LANDING BLVD, SUITE 1, PONTE VEDRA BEACH, FL 32082-1287
(904) 463-2284
(904) 543-7755
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
36593
TX
103T00000X
Psychologist
Primary
PY 7675
FL
103T00000X
Psychologist
PY003739
GA
Other
Enumeration date
08/18/2006
Last updated
07/18/2019
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