Provider Demographics
NPI:1699197210
Name:HENDRICKSON, RUTH ANNE (MA)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANNE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 W WILSHIRE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7777
Mailing Address - Country:US
Mailing Address - Phone:405-620-3464
Mailing Address - Fax:
Practice Address - Street 1:433 W WILSHIRE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7777
Practice Address - Country:US
Practice Address - Phone:405-620-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health