Provider Demographics
NPI:1073012415
Name:SHOOK, RUTH LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:LYNN
Last Name:SHOOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:SHOOK-ORR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:600 S CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4621
Mailing Address - Country:US
Mailing Address - Phone:847-606-1492
Mailing Address - Fax:
Practice Address - Street 1:1807 HICKS RD STE D
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1243
Practice Address - Country:US
Practice Address - Phone:847-213-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical