Provider Demographics
NPI:1972719466
Name:RUTKOWSKI, VANESSA (LAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 DICKSON DR
Mailing Address - Street 2:SUITE 26
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4796
Mailing Address - Country:US
Mailing Address - Phone:512-899-8996
Mailing Address - Fax:512-851-8996
Practice Address - Street 1:2111 DICKSON DR
Practice Address - Street 2:SUITE 26
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4796
Practice Address - Country:US
Practice Address - Phone:512-899-8996
Practice Address - Fax:512-851-8996
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist