Provider Demographics
NPI:1699820951
Name:ZUPANCIC, RUTH COLLEEN (BA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:COLLEEN
Last Name:ZUPANCIC
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:COLLEEN
Other - Last Name:BLACKNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5455 ALMIRA DR SE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8330
Mailing Address - Country:US
Mailing Address - Phone:360-373-5031
Mailing Address - Fax:
Practice Address - Street 1:5455 ALMIRA DR SE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8330
Practice Address - Country:US
Practice Address - Phone:360-373-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00031480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health