Provider Demographics
NPI:1245913359
Name:RUIZ, JONATHAN EMMANUEL (LMSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EMMANUEL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-4946
Mailing Address - Country:US
Mailing Address - Phone:913-961-9962
Mailing Address - Fax:
Practice Address - Street 1:825 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2323
Practice Address - Country:US
Practice Address - Phone:816-889-4642
Practice Address - Fax:816-889-1838
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230318291041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical