Provider Demographics
NPI:1386761112
Name:DRUEKE, MARY JO (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:DRUEKE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 RIVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-9304
Mailing Address - Country:US
Mailing Address - Phone:616-821-5260
Mailing Address - Fax:616-891-9186
Practice Address - Street 1:8851 RIVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-9304
Practice Address - Country:US
Practice Address - Phone:616-821-5260
Practice Address - Fax:616-891-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013039103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist