Individual
LANE-MICHAEL RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
707 S GRADY WAY, RENTON, WA 98057-3224
(425) 226-5062
Mailing address
707 S GRADY WAY, RENTON, WA 98057-3224
(425) 226-5062
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
10/12/2022
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