Provider Demographics
NPI:1497416408
Name:RUCKMAN, DANA ANSLIE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ANSLIE
Last Name:RUCKMAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ANSLIE
Other - Middle Name:
Other - Last Name:RUCKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7105 CROSSROADS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7105 CROSSROADS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2806
Practice Address - Country:US
Practice Address - Phone:615-285-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist