Provider Demographics
NPI:1851034789
Name:RUEFF, KELSEY COLLEEN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:COLLEEN
Last Name:RUEFF
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 1:905 N SCHEURMANN RD APT 6
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1865
Mailing Address - Country:US
Mailing Address - Phone:989-415-2531
Mailing Address - Fax:
Practice Address - Street 1:3710 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2160
Practice Address - Country:US
Practice Address - Phone:989-324-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty