Provider Demographics
NPI:1891888319
Name:RUECKHEIM, PATRICIA (LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RUECKHEIM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LOFTUS
Other - Last Name:RUECKHEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:7330 W COLLEGE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1157
Mailing Address - Country:US
Mailing Address - Phone:708-364-7272
Mailing Address - Fax:
Practice Address - Street 1:7330 W COLLEGE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1157
Practice Address - Country:US
Practice Address - Phone:708-364-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional