Provider Demographics
NPI:1326100645
Name:MATHEWS, RUTH M (PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:MATHEWS
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 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:66 E 3RD ST
Practice Address - Street 2:201
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3478
Practice Address - Country:US
Practice Address - Phone:507-452-7292
Practice Address - Fax:507-457-9887
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN938548700Medicaid
MN117761Medicaid
MN974T9MAOtherBCBS-MN
MNHP17766OtherHEALTHPARTNERS
MN731291012003OtherPREFERRED ONE
MN974T9MAOtherBCBS-MN