Provider Demographics
NPI:1093432585
Name:LANDGREN, RUSKEE (LMSW)
Entity Type:Individual
Prefix:
First Name:RUSKEE
Middle Name:
Last Name:LANDGREN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RUSKEE
Other - Middle Name:
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1640 POWERS FERRY RD.
Mailing Address - Street 2:BUILDING 14, SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:888-551-5168
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD.
Practice Address - Street 2:BUILDING 14, SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:888-551-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009647104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty