Provider Demographics
NPI:1467770594
Name:GARVIN, RUTH A (LCSW CSAC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:A
Last Name:GARVIN
Suffix:
Gender:F
Credentials:LCSW CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1740
Mailing Address - Country:US
Mailing Address - Phone:715-898-1665
Mailing Address - Fax:715-898-1240
Practice Address - Street 1:1905 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4917
Practice Address - Country:US
Practice Address - Phone:715-898-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14680-132101YA0400X
WI128564-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39174000Medicaid