Provider Demographics
NPI:1659523843
Name:RUGGIERO, CASEY NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:NICOLE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 RAINIER WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833
Mailing Address - Country:US
Mailing Address - Phone:406-360-3184
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGGINS AVE # 324
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4462
Practice Address - Country:US
Practice Address - Phone:406-360-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-1456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist