Provider Demographics
NPI:1770862013
Name:RUETZ, JULIA (PC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:RUETZ
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8970
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0970
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:419-479-3832
Practice Address - Street 1:5151 MONROE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3466
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:419-479-3832
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900405-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional