Provider Demographics
NPI:1821105594
Name:RURUP, CYNTHIA A (LISW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:RURUP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:730 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1242
Practice Address - Country:US
Practice Address - Phone:641-923-2651
Practice Address - Fax:641-923-2652
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43019OtherWELLMARK
IAI4822Medicare ID - Type Unspecified
IA43019OtherWELLMARK