Individual
STACY L RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1845 FAIRMOUNT BOX 109, WICHITA, KS 67260-0109
(316) 978-5419
(316) 978-5822
Mailing address
1845 FAIRMOUNT BOX 109, WICHITA, KS 67260-0109
(316) 978-5419
(316) 978-5822
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6178
KS
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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