Provider Demographics
NPI:1275389884
Name:JACKSON-WILLIAMS, RUCHELLE L
Entity Type:Individual
Prefix:MS
First Name:RUCHELLE
Middle Name:L
Last Name:JACKSON-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RUCHELLE
Other - Middle Name:L
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22149 CHATSFORD CIRCUIT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-6238
Mailing Address - Country:US
Mailing Address - Phone:240-498-9639
Mailing Address - Fax:
Practice Address - Street 1:40600 ANN ARBOR RD E STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4675
Practice Address - Country:US
Practice Address - Phone:240-498-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach