Provider Demographics
NPI:1376640847
Name:ANSON, AMYANSONRCN.COM RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMYANSONRCN.COM
Middle Name:RUTH
Last Name:ANSON
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 1:9020 TRIPP
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-791-5078
Mailing Address - Fax:847-251-9330
Practice Address - Street 1:3330 OLD GLENVIEW ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-791-5078
Practice Address - Fax:847-251-9330
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627266OtherBLUE CROSS BLUE SHIELD #