Provider Demographics
NPI:1518949197
Name:PRICE, RUTH IONE
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:IONE
Last Name:PRICE
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 1:976 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3854
Mailing Address - Country:US
Mailing Address - Phone:608-205-9878
Mailing Address - Fax:
Practice Address - Street 1:5610 MEDICAL CIR
Practice Address - Street 2:STE 25
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1227
Practice Address - Country:US
Practice Address - Phone:608-274-5871
Practice Address - Fax:608-274-5764
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3062125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40920400Medicaid