Provider Demographics
NPI:1518642370
Name:RUDOWICZ, REBECCA MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:RUDOWICZ
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:RUDOWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:5200 WILLOWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3831
Mailing Address - Country:US
Mailing Address - Phone:513-484-3455
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLOWOOD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3831
Practice Address - Country:US
Practice Address - Phone:513-484-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI23042831041C0700X
OHI.23042831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty