Provider Demographics
NPI:1821136532
Name:RUEL, DEBORA KAY
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:KAY
Last Name:RUEL
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:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-0732
Mailing Address - Country:US
Mailing Address - Phone:618-567-0925
Mailing Address - Fax:
Practice Address - Street 1:1400 VICKSBURG DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5760
Practice Address - Country:US
Practice Address - Phone:618-567-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-01-16
Deactivation Date:2014-09-24
Deactivation Code:
Reactivation Date:2022-09-07
Provider Licenses
StateLicense IDTaxonomies
IL178.019516101YM0800X, 101Y00000X, 101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional