Provider Demographics
NPI:1558422485
Name:RUCKER, WILLIAM M
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:RUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SOUTH 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4623
Mailing Address - Country:US
Mailing Address - Phone:402-391-2477
Mailing Address - Fax:402-397-4268
Practice Address - Street 1:820 SOUTH 75TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4623
Practice Address - Country:US
Practice Address - Phone:402-391-2477
Practice Address - Fax:402-397-4268
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker