Provider Demographics
NPI:1184353294
Name:RUDA, JILLIAN (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:RUDA
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GROUSE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2315
Mailing Address - Country:US
Mailing Address - Phone:724-984-9518
Mailing Address - Fax:
Practice Address - Street 1:315 GROUSE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2315
Practice Address - Country:US
Practice Address - Phone:724-984-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional