Provider Demographics
NPI:1346321619
Name:RUFFMAN, JILL VALERIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:VALERIE
Last Name:RUFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:VALERIE
Other - Last Name:RUFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-2007
Mailing Address - Country:US
Mailing Address - Phone:916-791-8530
Mailing Address - Fax:
Practice Address - Street 1:8757 AUBURN FOLSOM RD
Practice Address - Street 2:#2007
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-0350
Practice Address - Country:US
Practice Address - Phone:916-791-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-03-11
Deactivation Date:2010-05-17
Deactivation Code:
Reactivation Date:2015-03-04
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical