Provider Demographics
NPI:1104382159
Name:MARTINSON, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16284 SW CORNELIAN WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8845
Mailing Address - Country:US
Mailing Address - Phone:503-521-8613
Mailing Address - Fax:
Practice Address - Street 1:8303 SW LOCUST ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8816
Practice Address - Country:US
Practice Address - Phone:971-271-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health