Provider Demographics
NPI:1821503764
Name:RUIZ, ASHLEY (LSWAIC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7282 STINSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-4930
Mailing Address - Country:US
Mailing Address - Phone:253-857-5447
Mailing Address - Fax:253-857-0710
Practice Address - Street 1:7282 STINSON AVE STE B
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-857-5447
Practice Address - Fax:253-857-0710
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60779613106S00000X
WALW610145191041C0700X
WASC607001161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACB60779613OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WASC60700116OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WA2142431Medicaid