Provider Demographics
NPI:1154333664
Name:RUTH, KATHLEEN JO (LSCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JO
Last Name:RUTH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S HOLYOKE ST
Mailing Address - Street 2:BUILDING G SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2928
Mailing Address - Country:US
Mailing Address - Phone:316-636-2888
Mailing Address - Fax:316-636-2366
Practice Address - Street 1:901 S HOLYOKE ST
Practice Address - Street 2:BUILDING G SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2928
Practice Address - Country:US
Practice Address - Phone:316-636-2888
Practice Address - Fax:316-636-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 18651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069381OtherBCBS OF KANSAS
KSA008OtherTRIWEST
KS4463OtherPPK
KS069381OtherBCBS OF KANSAS
KS4463OtherPPK