Provider Demographics
NPI:1497047302
Name:KELLOGG, RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7286 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1620
Mailing Address - Country:US
Mailing Address - Phone:925-828-8470
Mailing Address - Fax:
Practice Address - Street 1:7286 SHEFFIELD LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1620
Practice Address - Country:US
Practice Address - Phone:925-828-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical