Provider Demographics
NPI:1205019288
Name:GUENGERICH, RUTH LAPP
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:LAPP
Last Name:GUENGERICH
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 1:221 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2713
Mailing Address - Country:US
Mailing Address - Phone:574-262-3597
Mailing Address - Fax:
Practice Address - Street 1:221 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2713
Practice Address - Country:US
Practice Address - Phone:574-262-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000685A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health