Provider Demographics
NPI:1952374431
Name:RUTH, MARYLEE
Entity type:Individual
Prefix:
First Name:MARYLEE
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 1:94-227 PAIOA PL
Mailing Address - Street 2:#B104
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 S KING ST
Practice Address - Street 2:#907
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1922
Practice Address - Country:US
Practice Address - Phone:808-548-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD 34231H00000X
HIHA48231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9274-2OtherHMSA
HIAUD34-01OtherMDX HAWAII
HI593OtherALOHACARE
HI0000205302OtherHMSA QUEST
HI071312-03Medicaid
FL03856OtherHEARUSA
HI071312-03Medicaid