Provider Demographics
NPI:1417782962
Name:RUEGG, JUSTINE ROSE
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ROSE
Last Name:RUEGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6247
Mailing Address - Country:US
Mailing Address - Phone:415-715-7922
Mailing Address - Fax:
Practice Address - Street 1:540 MIDDLE RINCON RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3107
Practice Address - Country:US
Practice Address - Phone:707-335-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)