Provider Demographics
NPI:1154657864
Name:RUKSTELE, EUGENIJA ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:EUGENIJA
Middle Name:ANN
Last Name:RUKSTELE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:EUGENIHA
Other - Middle Name:ANN
Other - Last Name:ERVASTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2614
Mailing Address - Country:US
Mailing Address - Phone:313-966-9094
Mailing Address - Fax:313-966-9418
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 114
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-966-9094
Practice Address - Fax:313-966-9418
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010048361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical