Provider Demographics
NPI:1578165973
Name:RUEGGER, DAWSON JAY
Entity Type:Individual
Prefix:
First Name:DAWSON
Middle Name:JAY
Last Name:RUEGGER
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 1:850 S 1050 W APT D203
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3352
Mailing Address - Country:US
Mailing Address - Phone:435-841-1989
Mailing Address - Fax:
Practice Address - Street 1:850 S 1050 W APT D203
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3352
Practice Address - Country:US
Practice Address - Phone:435-841-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1497177103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst