Provider Demographics
NPI:1356082911
Name:TUCK, RALPH (LADC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:TUCK
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2121
Mailing Address - Country:US
Mailing Address - Phone:218-540-0142
Mailing Address - Fax:218-540-0126
Practice Address - Street 1:2000 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2121
Practice Address - Country:US
Practice Address - Phone:507-450-1438
Practice Address - Fax:218-540-0126
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)