Provider Demographics
NPI:1548033780
Name:RUCHTI, ALEXANDER ADAM
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ADAM
Last Name:RUCHTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 LILLEHAMMER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-3650
Mailing Address - Country:US
Mailing Address - Phone:608-228-6180
Mailing Address - Fax:
Practice Address - Street 1:409 LILLEHAMMER LN
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-3650
Practice Address - Country:US
Practice Address - Phone:608-228-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRBT-22-205576106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician