Individual
IDREES M RUTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5901 N CICERO AVE STE 210, CHICAGO, IL 60646-5718
(773) 780-1448
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1197354
IL
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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