Provider Demographics
NPI:1235156043
Name:VAN VRANKEN, RUTH ANN (PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:VAN VRANKEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4646
Mailing Address - Country:US
Mailing Address - Phone:307-637-6146
Mailing Address - Fax:307-433-8107
Practice Address - Street 1:518 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4646
Practice Address - Country:US
Practice Address - Phone:307-637-6146
Practice Address - Fax:307-433-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW303461Medicare PIN