Provider Demographics
NPI:1821725441
Name:RUGH, KATHLEEN E (CSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:RUGH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 E 2120 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5854
Mailing Address - Country:US
Mailing Address - Phone:609-533-9669
Mailing Address - Fax:
Practice Address - Street 1:520 E 770 N # 84097
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4101
Practice Address - Country:US
Practice Address - Phone:609-533-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical