Provider Demographics
NPI:1659428589
Name:LECKRONE, RUTH MAXINE (LMSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MAXINE
Last Name:LECKRONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ANN
Mailing Address - State:MI
Mailing Address - Zip Code:49650-9720
Mailing Address - Country:US
Mailing Address - Phone:231-275-7988
Mailing Address - Fax:
Practice Address - Street 1:3180 RACQUET CLUB DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-922-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15023691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical