Provider Demographics
NPI:1386402238
Name:RUUD, JENNA CHERILYN (SUDPT)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:CHERILYN
Last Name:RUUD
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 W BAKERVIEW RD APT C402
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8178
Mailing Address - Country:US
Mailing Address - Phone:360-603-8381
Mailing Address - Fax:
Practice Address - Street 1:3240 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1318
Practice Address - Country:US
Practice Address - Phone:360-450-5025
Practice Address - Fax:360-734-3270
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61406813101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)