Provider Demographics
NPI:1790849008
Name:RUTSCH, DIANE KAY
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:RUTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:LEATHERBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CISW
Mailing Address - Street 1:N82W14375 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3954
Mailing Address - Country:US
Mailing Address - Phone:262-251-2118
Mailing Address - Fax:
Practice Address - Street 1:1025 S MOORLAND RD STE 403
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6945
Practice Address - Country:US
Practice Address - Phone:262-786-0411
Practice Address - Fax:262-786-9954
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1893-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical