Provider Demographics
NPI:1972504256
Name:TETZ, RUTH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:TETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:ROEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7318 INTERNATIONAL DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9560
Mailing Address - Country:US
Mailing Address - Phone:419-867-0301
Mailing Address - Fax:419-867-0307
Practice Address - Street 1:7318 INTERNATIONAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9560
Practice Address - Country:US
Practice Address - Phone:419-867-0301
Practice Address - Fax:419-867-0307
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP08802Medicare ID - Type Unspecified