Provider Demographics
NPI:1073644654
Name:SEIDER, RUTH LEONA (ATRBC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:LEONA
Last Name:SEIDER
Suffix:
Gender:F
Credentials:ATRBC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W HOMESTEAD TRL
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3215
Mailing Address - Country:US
Mailing Address - Phone:262-241-8275
Mailing Address - Fax:
Practice Address - Street 1:1414 W HOMESTEAD TRL
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3215
Practice Address - Country:US
Practice Address - Phone:262-241-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3815-125101YP2500X
WI79-036221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist