Provider Demographics
NPI:1487284964
Name:RUEGG, JESSICA JOANNA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOANNA
Last Name:RUEGG
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 1:116 MCDOWELL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-4923
Mailing Address - Country:US
Mailing Address - Phone:828-675-2767
Mailing Address - Fax:
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-2925
Practice Address - Country:US
Practice Address - Phone:828-682-1551
Practice Address - Fax:828-675-9312
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12855101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487284964Medicaid