Provider Demographics
NPI:1396868055
Name:RAEBER, RUTH E
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:RAEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-0326
Mailing Address - Country:US
Mailing Address - Phone:618-946-0374
Mailing Address - Fax:217-839-4705
Practice Address - Street 1:10247 COLUMBEY DR
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-2250
Practice Address - Country:US
Practice Address - Phone:217-839-4705
Practice Address - Fax:217-839-4705
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist