Provider Demographics
NPI:1316689128
Name:LEMMON, RUTHANNE MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:RUTHANNE
Middle Name:MARIE
Last Name:LEMMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S 4TH STREET TRAFFICWAY
Mailing Address - Street 2:L-116-HBPC
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-731-9634
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH STREET TRAFFICWAY
Practice Address - Street 2:L-116-HBPC
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-731-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11397104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker