Provider Demographics
NPI:1710311865
Name:RODRIGUEZ-RUICH, ALEXANDRA ELISE
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ELISE
Last Name:RODRIGUEZ-RUICH
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 1:1825 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3443
Mailing Address - Country:US
Mailing Address - Phone:219-776-3910
Mailing Address - Fax:
Practice Address - Street 1:1825 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3443
Practice Address - Country:US
Practice Address - Phone:219-776-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist