Provider Demographics
NPI:1134469067
Name:CEDAR FACE, RUTH L (MAC, CCDC II)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:CEDAR FACE
Suffix:
Gender:F
Credentials:MAC, CCDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1201
Mailing Address - Street 2:EAST HIGHWAY 18
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-0770
Mailing Address - Country:US
Mailing Address - Phone:605-867-5131
Mailing Address - Fax:605-867-3274
Practice Address - Street 1:EAST HIGHWAY 18
Practice Address - Street 2:IHS COMPOUND
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-5131
Practice Address - Fax:605-867-3274
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD011077101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)