Provider Demographics
NPI:1326030545
Name:RUHLAND, MARY M (LISW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:RUHLAND
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:COAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1339 NODAWAY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68743-3077
Mailing Address - Country:US
Mailing Address - Phone:402-632-7202
Mailing Address - Fax:712-277-3208
Practice Address - Street 1:705 DOUGLAS,
Practice Address - Street 2:SUITE325, BENSON BLDG
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1606
Practice Address - Country:US
Practice Address - Phone:712-277-3200
Practice Address - Fax:712-277-3208
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA92026101YA0400X
IA012841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03727OtherBCBS
IA103277513OtherUBH
IA203761197001OtherAPS
IA127712OtherVALUE OPTIONS
1326030545OtherNIP
IA2190223Medicaid
IA10827OtherMIDLANDS CHOICE
IA203761197OtherPRINCIPAL
IA203761197Medicaid
IA253668OtherMHN
1326030545OtherNIP
IAS83077Medicare UPIN
IAI16668Medicare ID - Type UnspecifiedGROUP
IA203761197OtherPRINCIPAL