Provider Demographics
NPI:1215013313
Name:PEARSON, RUTH KATHRYN (MA, LCPC, CSAT, CMAT)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:KATHRYN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MA, LCPC, CSAT, CMAT
Other - Prefix:MS
Other - First Name:R.
Other - Middle Name:KATHRYN
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC, CSAT, CMAT
Mailing Address - Street 1:5116 EAGLE RDG
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7811
Mailing Address - Country:US
Mailing Address - Phone:217-787-8360
Mailing Address - Fax:
Practice Address - Street 1:3021 MONTVALE DR
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5389
Practice Address - Country:US
Practice Address - Phone:217-787-8780
Practice Address - Fax:217-726-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional