Provider Demographics
NPI:1396416319
Name:RUDA, SHAUNA (LSW)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:RUDA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPEER BLVD APT 314
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2657
Mailing Address - Country:US
Mailing Address - Phone:720-560-2710
Mailing Address - Fax:
Practice Address - Street 1:3201 S TAMARAC DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4360
Practice Address - Country:US
Practice Address - Phone:720-642-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009923748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health