Provider Demographics
NPI:1467790857
Name:RUDD, JEANETTE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:RUDD
Suffix:
Gender:
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:RUDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:8139 NEW LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4682
Mailing Address - Country:US
Mailing Address - Phone:502-430-2012
Mailing Address - Fax:
Practice Address - Street 1:8139 NEW LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4682
Practice Address - Country:US
Practice Address - Phone:502-430-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002386A106H00000X
KY281856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist