Individual
MS. DESIREE FORREST RUDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT,CADC I
Contact information
Practice address
2111 FRONT ST NE STE 3-101, SALEM, OR 97301-0038
(503) 508-7868
Mailing address
830 SAGINAW ST S, SALEM, OR 97302-4122
(503) 503-7868
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-08-32
OR
172M00000X
Mechanotherapist
14427
OR
Other
Enumeration date
09/07/2010
Last updated
07/24/2019
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