Provider Demographics
NPI:1659102234
Name:RUTH, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 GABLE DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-5515
Mailing Address - Country:US
Mailing Address - Phone:952-999-0859
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BLVD STE 370
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1009
Practice Address - Country:US
Practice Address - Phone:952-395-1441
Practice Address - Fax:952-395-1442
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional