Provider Demographics
NPI:1891261988
Name:RUCKER, ROSE MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:RUCKER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16319 EAGLEWOOD SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6292
Mailing Address - Country:US
Mailing Address - Phone:281-313-3203
Mailing Address - Fax:
Practice Address - Street 1:16319 EAGLEWOOD SHADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6292
Practice Address - Country:US
Practice Address - Phone:281-313-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-24
Deactivation Date:2018-10-17
Deactivation Code:
Reactivation Date:2018-10-24
Provider Licenses
StateLicense IDTaxonomies
TX1743434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician