Provider Demographics
NPI:1487929709
Name:WAIN, RUTH MORGAN (LICENSED PSYCHOL)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:MORGAN
Last Name:WAIN
Suffix:
Gender:F
Credentials:LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7434
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417
Mailing Address - Country:US
Mailing Address - Phone:650-641-2682
Mailing Address - Fax:
Practice Address - Street 1:4524 INTELCO LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5941
Practice Address - Country:US
Practice Address - Phone:650-641-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019051103TC0700X
WAPY 60474804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical