Provider Demographics
NPI:1801228499
Name:RUTH GAUSE, ROBIN (CLC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:RUTH GAUSE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31232
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-0021
Mailing Address - Country:US
Mailing Address - Phone:803-450-3144
Mailing Address - Fax:
Practice Address - Street 1:510 FAIRWOOD LAKES AVE
Practice Address - Street 2:14-C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:803-450-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCALPP-79359174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN