Provider Demographics
NPI:1659951887
Name:GABEHART, RUTH SIMONIS
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:SIMONIS
Last Name:GABEHART
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 1:111 W COTTOM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-5008
Mailing Address - Country:US
Mailing Address - Phone:502-523-7405
Mailing Address - Fax:
Practice Address - Street 1:111 W COTTOM AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-5008
Practice Address - Country:US
Practice Address - Phone:502-523-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty