Provider Demographics
NPI:1790241347
Name:ORME-JOHNSON, RUTH D
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:ORME-JOHNSON
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 1:1522 W VICTORIA ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-5403
Mailing Address - Country:US
Mailing Address - Phone:617-834-1811
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE STE 215
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3240
Practice Address - Country:US
Practice Address - Phone:773-880-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490199481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical