Provider Demographics
NPI:1619466984
Name:RUCKER, JAMEESA
Entity Type:Individual
Prefix:
First Name:JAMEESA
Middle Name:
Last Name:RUCKER
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 1:6449 MONTGOMERY RD APT 8
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1570
Mailing Address - Country:US
Mailing Address - Phone:513-886-0866
Mailing Address - Fax:
Practice Address - Street 1:7162 READING RD STE 900
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3879
Practice Address - Country:US
Practice Address - Phone:513-559-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker