Provider Demographics
NPI:1447696695
Name:RUIZ, MIKKI (MSW)
Entity type:Individual
Prefix:
First Name:MIKKI
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2016
Mailing Address - Country:US
Mailing Address - Phone:574-255-4976
Mailing Address - Fax:574-255-1882
Practice Address - Street 1:2809 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRAIL CREEK
Practice Address - State:IN
Practice Address - Zip Code:46360-5709
Practice Address - Country:US
Practice Address - Phone:574-361-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical