Provider Demographics
NPI:1154662989
Name:VONK, RUTH M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:M
Last Name:VONK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 W RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2161
Mailing Address - Country:US
Mailing Address - Phone:208-968-1141
Mailing Address - Fax:208-321-7750
Practice Address - Street 1:6311 W RANDOLPH DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2161
Practice Address - Country:US
Practice Address - Phone:208-968-1141
Practice Address - Fax:208-321-7750
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-8291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical