Provider Demographics
NPI:1316195316
Name:RUCKER, BARBARA ELIZABETH (MA NCSP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELIZABETH
Last Name:RUCKER
Suffix:
Gender:F
Credentials:MA NCSP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13179 HUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038
Mailing Address - Country:US
Mailing Address - Phone:317-570-6658
Mailing Address - Fax:
Practice Address - Street 1:13179 HUFF BLVD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-570-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1007924103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool