MRS. ELIZABETH ANN RUDOLPH (NPI# 1710262233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710262233 |
| Entity Type | Individual |
| Full Name | MRS. ELIZABETH ANN RUDOLPH |
| Credential | LLP |
| Practice Address |
1200 N West Ave Jackson MI 49202-2179 |
| Mailing Address |
301 Miller Dr Albion MI 49224-1140 |
| Practice Telephone | 5177803390 |
| Mailing Telephone | 2698328803 |
| Enumeration Date | 2011-10-16 |
| Last Update Date | 2015-03-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6301014357 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912038605 | Elizabeth T Rudolph | Nurse Practitioner | 4319 Stone Way N, Seattle, WA 98103-7420 | 2007-03-07 |
| 1194324707 | Elizabeth Rudolph | Massage Therapist | 5568 S Fort Apache Rd, Las Vegas, NV 89148-3602 | 2020-10-23 |
| 1871993212 | Elizabeth Rudolph | Case Manager/Care Coordinator | 110 N Mill St, Festus, MO 63028-1816 | 2014-09-03 |
| Street Address |
1200 N WEST AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49202-2179 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366496051 | Dennis J Glandon | Social Worker | 1200 N West Ave, Suite 400, Jackson, MI 49202-2179 | 2006-05-19 |
| 1669084810 | Sarah Lynn Ackerman | Case Manager/Care Coordinator | 1200 N West Ave, Jackson, MI 49202-2179 | 2020-08-19 |
| 1265055925 | Kelly Ann Parten | Case Manager/Care Coordinator | 1200 N West Ave, Jackson, MI 49202-2179 | 2020-05-28 |
| 1568084143 | James L Horrigan II | Social Worker | 1200 N West Ave, Jackson, MI 49202-2179 | 2020-05-18 |
| 1821619099 | Kimberly Kay Bomar | Social Worker | 1200 N West Ave, Jackson, MI 49202-2179 | 2020-04-29 |
| 1255951281 | Stephanie Elizabeth Goodrich | Case Manager/Care Coordinator | 1200 N West Ave, Jackson, MI 49202-2179 | 2020-04-20 |
| 1104463306 | Chad Lige | Health Educator | 1200 N West Ave, Jackson, MI 49202-2179 | 2019-12-06 |
| 1578100244 | Vickie Lynn Kittle | Peer Specialist | 1200 N West Ave, Jackson, MI 49202-2179 | 2019-12-02 |
| 1710522701 | Crystal Ann Chaffee | Social Worker | 1200 N West Ave, Jackson, MI 49202-2179 | 2019-11-13 |
| 1184269169 | Stephanie Leeann Justice | Case Manager/Care Coordinator | 1200 N West Ave, Jackson, MI 49202-2179 | 2019-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821590316 | Leslie Dominique Barroso | Social Worker | 834 Kennedy St, Jackson, MI 49202 | 2018-03-01 |
| 1073011136 | Nicole Szarek | Social Worker | 1200 N. West Ave, Jackson, MI 49202 | 2018-01-24 |
| 1598299430 | Cedric Griffin | Behavior Technician | 950 W. Monroe St, Jackson, MI 49202 | 2017-04-18 |
| 1285081612 | Patricia Decker | Psychologist | 950 West Monroe, Suite 500, Jackson, MI 49202 | 2016-05-16 |
| 1619344314 | Erica Ries | Social Worker | 1200 N West Ave Ste 800, Jackson, MI 49202 | 2015-08-28 |
| 1184007189 | Sarah Johnson | Behavioral Analyst | 818 Winifred St, Jackson, MI 49202 | 2015-07-08 |
| 1871971697 | Scott A Watterson Dds, Pllc | Dentist | 1030 Laurence Ave, Suite 3, Jackson, MI 49202 | 2015-05-13 |
| 1043608680 | Brenda Beverly | Counselor | 1190 West, 1190 West Suite 812, Jackson, MI 49202 | 2015-01-06 |
| 1295091593 | Natalie Ann Kember | Social Worker | 1206 Clinton, Jackson, MI 49202 | 2012-04-11 |
| 1912218728 | Tina Marie Pierce | Respite Care | 225 N Wisner St, Jakson, MI 49202 | 2010-06-25 |
| Find all providers in zip 49202 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043756174 | Maribeth L. Hesser | Psychologist | 6675 N Upper Cascade Dr, Jackson, WY 83001-9390 | 2017-01-12 |
| 1215375746 | Payne Behavioral Medicine | Psychologist | 4005 N State St Ste N, Jackson, MS 39206-5755 | 2013-06-06 |
| 1598002610 | Kimberly D Weaver | Psychologist | 207 First Street, Jackson, MI 49201 | 2013-01-09 |
| 1497027775 | Fitness Clinic | Psychologist | 2219 Greenway Dr, Jackson, MS 39204-3202 | 2012-02-02 |
| 1760752976 | Mitchell S. Weisbrod, Psy.d., Pllc | Psychologist | 115 S West Ave Ste 1, Jackson, MI 49201-2085 | 2012-01-04 |
| 1275830887 | Martin E Cleveland Phd Pllc | Psychologist | 5 Brentmeade Cv, Jackson, TN 38305-6448 | 2011-02-16 |
| 1154636611 | Shannon Monique Moore | Psychologist | 1675 Lakeland Dr Ste 304, Jackson, MS 39216 | 2010-08-09 |
| 1598076903 | Nanetta S Payne | Psychologist | 4005 N State St, Suite N, Jackson, MS 39206-5755 | 2010-06-30 |
| 1932422763 | Marion Counseling Services, Pllc | Psychologist | 2095 Dunbarton Dr, Suite 103, Jackson, MS 39216-5017 | 2010-03-08 |
| 1457548737 | Deborah Ruddy Hansen | Psychologist | 6 Universal Way, Jackson, MI 49202-1455 | 2007-10-01 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.