Provider Demographics
NPI:1700813482
Name:EVANS, RUTH ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2228
Mailing Address - Country:US
Mailing Address - Phone:563-263-3869
Mailing Address - Fax:563-263-3869
Practice Address - Street 1:2015 W BAY DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2228
Practice Address - Country:US
Practice Address - Phone:563-263-3869
Practice Address - Fax:563-263-3869
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0059378Medicaid
IA0059378Medicaid