Provider Demographics
NPI:1821154451
Name:CHRISTENSEN, RUTH L (PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17603 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9134
Mailing Address - Country:US
Mailing Address - Phone:425-743-7643
Mailing Address - Fax:425-743-7645
Practice Address - Street 1:17603 NORTH RD
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9134
Practice Address - Country:US
Practice Address - Phone:425-743-7643
Practice Address - Fax:425-743-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA170629OtherVALUE OPTIONS
WAR00118OtherREGENCE BLUE SHEILD