Provider Demographics
NPI:1336559863
Name:RUCKS, KAREN NORIKO (MS)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:NORIKO
Last Name:RUCKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SHEBOYGAN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4367
Mailing Address - Country:US
Mailing Address - Phone:920-251-6394
Mailing Address - Fax:
Practice Address - Street 1:74 S MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4274
Practice Address - Country:US
Practice Address - Phone:920-251-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1600-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health