Provider Demographics
NPI:1447057120
Name:RUXLOW, SIGRID ELISE
Entity type:Individual
Prefix:
First Name:SIGRID
Middle Name:ELISE
Last Name:RUXLOW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 N OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-3010
Mailing Address - Country:US
Mailing Address - Phone:309-404-8307
Mailing Address - Fax:
Practice Address - Street 1:202 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3638
Practice Address - Country:US
Practice Address - Phone:309-663-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician