Provider Demographics
NPI:1376779553
Name:BUSMAN, RUTH CHERYL (LP)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:CHERYL
Last Name:BUSMAN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:C
Other - Last Name:OBERSAAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:2260 ARIEL ST N
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2852
Mailing Address - Country:US
Mailing Address - Phone:651-779-6180
Mailing Address - Fax:
Practice Address - Street 1:2260 ARIEL ST N
Practice Address - Street 2:
Practice Address - City:NORTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2852
Practice Address - Country:US
Practice Address - Phone:651-779-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical