Provider Demographics
NPI:1467790857
Name:RUDD, JEANETTE (MS, MFTA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:MS, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 BIG TREE CIR APT E
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5855
Mailing Address - Country:US
Mailing Address - Phone:502-712-1517
Mailing Address - Fax:
Practice Address - Street 1:13121 EASTPOINT PARK BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4192
Practice Address - Country:US
Practice Address - Phone:502-612-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist