Organization
JACQUE RUCH LCSW, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN J RUCH LCSW (OWNER)
(815) 243-8332
Entity
Organization
Contact information
Practice address
6975 REDANSA DR, ROCKFORD, IL 61108-1201
(815) 398-7000
(815) 395-0671
Mailing address
4635 BEDFORDSHIRE DR, LOVES PARK, IL 61111-4481
(815) 243-8332
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149015073
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407129471
NPI
IL
Enumeration date
09/29/2014
Last updated
09/29/2014
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