Provider Demographics
NPI:1801271648
Name:BLAKE, RUTH ANN (LMSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:PROPST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2306
Practice Address - Country:US
Practice Address - Phone:248-955-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097221104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669451944Medicaid