Provider Demographics
NPI:1760527097
Name:ROSE, RUTH (MS)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 18TH ST S APT 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2311
Practice Address - Country:US
Practice Address - Phone:701-451-4900
Practice Address - Fax:701-451-5057
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND9398240OtherPHCS
ND62-35858OtherMEDICA UBH
ND58103-A002OtherTRI WEST
ND2081553OtherCIGNA
MN2352430OtherAMERICA'S PPO
NDHP35515OtherHEALTH PARTNERS
ND113182OtherU CARE
ND15489OtherBCBS ND
SD6576240Medicaid
ND990991042776OtherBHP PREFERRED 1
MN07F46ROOtherBCBS MN
ND990991042776OtherBHP PREFERRED 1
ND15489OtherBCBS ND