Provider Demographics
NPI:1578713715
Name:FORMAN, RUTH ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELIZABETH
Last Name:FORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ELIZABETH
Other - Last Name:VARGAS DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4215
Mailing Address - Country:US
Mailing Address - Phone:541-349-0301
Mailing Address - Fax:
Practice Address - Street 1:944 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5106
Practice Address - Country:US
Practice Address - Phone:541-349-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health