Provider Demographics
NPI:1720080765
Name:KOOIMAN, RUTH L (LP)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:L
Last Name:KOOIMAN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:400 S SYCAMORE AVE
Mailing Address - Street 2:STE 105-3
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-1246
Mailing Address - Country:US
Mailing Address - Phone:605-334-3739
Mailing Address - Fax:605-334-7752
Practice Address - Street 1:215 N CEDAR ST
Practice Address - Street 2:BETHESDA CHRISTIAN COUNSELING
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1626
Practice Address - Country:US
Practice Address - Phone:800-463-4005
Practice Address - Fax:605-334-7752
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist