Provider Demographics
NPI:1063174951
Name:NATHANIEL, RUTH SHANIKA
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:SHANIKA
Last Name:NATHANIEL
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 1:13139 PENNSYLVANIA CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1726
Mailing Address - Country:US
Mailing Address - Phone:773-328-9810
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4192
Practice Address - Country:US
Practice Address - Phone:312-772-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health