Provider Demographics
NPI:1841525110
Name:RUDERSDORF, ALLISON ANN (BA)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:ANN
Last Name:RUDERSDORF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 S PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1126
Mailing Address - Country:US
Mailing Address - Phone:303-761-7991
Mailing Address - Fax:
Practice Address - Street 1:5524 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1126
Practice Address - Country:US
Practice Address - Phone:303-761-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020095Medicaid