Provider Demographics
NPI:1740659838
Name:RUTH, SARAH LUCETTA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LUCETTA
Last Name:RUTH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:LUCETTA
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:225 PRAIRIE VIEW DR APT 8142
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7132
Mailing Address - Country:US
Mailing Address - Phone:620-215-3726
Mailing Address - Fax:
Practice Address - Street 1:105 VALLEY WEST DR STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3902
Practice Address - Country:US
Practice Address - Phone:515-223-4368
Practice Address - Fax:515-453-2368
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1740659838Medicaid