Provider Demographics
NPI:1528417839
Name:RUDD-HEILIG, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:RUDD-HEILIG
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 1:2195 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2624
Mailing Address - Country:US
Mailing Address - Phone:208-769-1406
Mailing Address - Fax:208-769-1430
Practice Address - Street 1:2195 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2624
Practice Address - Country:US
Practice Address - Phone:208-769-1406
Practice Address - Fax:208-769-1430
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker