1043553423 NPI number — MRS. RUTH ALICIA SOBECK MS, LMFT

Table of content: MRS. RUTH ALICIA SOBECK MS, LMFT (NPI 1043553423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043553423 NPI number — MRS. RUTH ALICIA SOBECK MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBECK
Provider First Name:
RUTH
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
RUTH
Provider Other Middle Name:
ALICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043553423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W175N11120 STONEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53022-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-438-1772
Provider Business Mailing Address Fax Number:
262-293-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54935-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-438-1772
Provider Business Practice Location Address Fax Number:
262-293-9737
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1057-124 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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