Provider Demographics
NPI:1407276488
Name:RUDDER, RENEISHA
Entity Type:Individual
Prefix:MS
First Name:RENEISHA
Middle Name:
Last Name:RUDDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 ZACHARY CIR
Mailing Address - Street 2:APT 8
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-6710
Mailing Address - Country:US
Mailing Address - Phone:502-640-7561
Mailing Address - Fax:
Practice Address - Street 1:2210 TUCKER STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4525
Practice Address - Country:US
Practice Address - Phone:502-366-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor