Provider Demographics
NPI:1972835247
Name:RUSTER, RAEANNE LEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RAEANNE
Middle Name:LEE
Last Name:RUSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13642 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9691
Mailing Address - Country:US
Mailing Address - Phone:616-844-2900
Mailing Address - Fax:616-844-1571
Practice Address - Street 1:109 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2095
Practice Address - Country:US
Practice Address - Phone:616-844-2900
Practice Address - Fax:616-844-1571
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087333101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor