Provider Demographics
NPI:1366070831
Name:RUEGSEGGER, MAXWELL REID (DP-C)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:REID
Last Name:RUEGSEGGER
Suffix:
Gender:M
Credentials:DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 N M 52 STE 1
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1025
Mailing Address - Country:US
Mailing Address - Phone:989-723-8230
Mailing Address - Fax:
Practice Address - Street 1:1480 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1290
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:989-723-8230
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)