Provider Demographics
NPI:1336788504
Name:VINCENT, RUTH E (LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:E
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6616
Mailing Address - Country:US
Mailing Address - Phone:773-392-8692
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY STE 111D
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1465
Practice Address - Country:US
Practice Address - Phone:847-813-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional