Provider Demographics
NPI:1285029280
Name:RUDER, CHRIS (MFT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:RUDER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:RUDER-VASCONEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1711 EMERY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18484 BLAIR ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8717
Practice Address - Country:US
Practice Address - Phone:715-318-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI442-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist