1215013313 NPI number — MS. RUTH KATHRYN PEARSON MA, LCPC, CSAT, CMAT

Table of content: MS. RUTH KATHRYN PEARSON MA, LCPC, CSAT, CMAT (NPI 1215013313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215013313 NPI number — MS. RUTH KATHRYN PEARSON MA, LCPC, CSAT, CMAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
RUTH
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCPC, CSAT, CMAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEARSON
Provider Other First Name:
R.
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LCPC, CSAT, CMAT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215013313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5116 EAGLE RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62711-7811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-787-8360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 MONTVALE DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62704-5389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-787-8780
Provider Business Practice Location Address Fax Number:
217-726-8220
Provider Enumeration Date:
10/31/2006

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: 101YP2500X , with the licence number:  180-002016 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com