Provider Demographics
NPI:1336893478
Name:RUPPERT, EMILY MARIE (TLMHC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S LAKEPORT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9533
Mailing Address - Country:US
Mailing Address - Phone:122-221-4597
Mailing Address - Fax:712-222-1460
Practice Address - Street 1:4300 S LAKEPORT ST STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9533
Practice Address - Country:US
Practice Address - Phone:122-221-4597
Practice Address - Fax:712-222-1460
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health