Provider Demographics
NPI:1760776801
Name:RUCKER, CHERIE DONNETTE (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:DONNETTE
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 ALGER ST SE STE 6
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3809
Mailing Address - Country:US
Mailing Address - Phone:616-777-7399
Mailing Address - Fax:616-773-1383
Practice Address - Street 1:1333 ALGER ST SE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3809
Practice Address - Country:US
Practice Address - Phone:616-777-7399
Practice Address - Fax:616-773-1383
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI211715928Medicaid