Provider Demographics
NPI:1578114906
Name:RUHSTORFER, AMBER ANNETTE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ANNETTE
Last Name:RUHSTORFER
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 1:2549 JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3678
Mailing Address - Country:US
Mailing Address - Phone:517-614-4714
Mailing Address - Fax:
Practice Address - Street 1:2549 JOLLY RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3678
Practice Address - Country:US
Practice Address - Phone:517-614-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2316684909Medicaid