Provider Demographics
NPI:1417549619
Name:RUCKER, STEVEN WILSON (MS, CIH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILSON
Last Name:RUCKER
Suffix:
Gender:M
Credentials:MS, CIH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:TERRACE PARK
Mailing Address - State:OH
Mailing Address - Zip Code:45174-1119
Mailing Address - Country:US
Mailing Address - Phone:513-248-0081
Mailing Address - Fax:
Practice Address - Street 1:207 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:TERRACE PARK
Practice Address - State:OH
Practice Address - Zip Code:45174-1119
Practice Address - Country:US
Practice Address - Phone:513-248-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIND-10821171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor