Provider Demographics
NPI:1881810190
Name:RUCKHEIM, CASEY LARAE (NCTMB)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LARAE
Last Name:RUCKHEIM
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50368 105TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERS PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56361-4839
Mailing Address - Country:US
Mailing Address - Phone:320-815-0986
Mailing Address - Fax:
Practice Address - Street 1:219 WEST SOO ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PARKERS PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56361
Practice Address - Country:US
Practice Address - Phone:320-815-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist