Provider Demographics
NPI:1982215703
Name:RUFFER, RUDOLPH (LMSW)
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:
Last Name:RUFFER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WINDING WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7819
Mailing Address - Country:US
Mailing Address - Phone:517-505-1140
Mailing Address - Fax:
Practice Address - Street 1:524 E MILHAM AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1473
Practice Address - Country:US
Practice Address - Phone:269-264-5053
Practice Address - Fax:616-552-1619
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker