Provider Demographics
NPI:1477653624
Name:MESCHIEVITZ, RUTH (MSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MESCHIEVITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2407
Mailing Address - Country:US
Mailing Address - Phone:218-728-4491
Mailing Address - Fax:218-728-4404
Practice Address - Street 1:1500 N 34TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4477
Practice Address - Country:US
Practice Address - Phone:715-392-8216
Practice Address - Fax:715-392-6055
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39554300Medicaid