Provider Demographics
NPI:1386816015
Name:RUCKSTUHL, TANYA M (LICSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:M
Last Name:RUCKSTUHL
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16010 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6406
Mailing Address - Country:US
Mailing Address - Phone:206-375-7690
Mailing Address - Fax:
Practice Address - Street 1:2611 NE 125TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-375-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000066711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical