Provider Demographics
NPI:1902937071
Name:BUNKELMANN, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BUNKELMANN
Suffix:
Gender:F
Credentials:
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 9168
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9168
Mailing Address - Country:US
Mailing Address - Phone:561-741-0000
Mailing Address - Fax:561-741-0002
Practice Address - Street 1:3401 PGA BLVD
Practice Address - Street 2:STE #300
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-741-0000
Practice Address - Fax:561-741-0002
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 3703104100000X
FLSW3703222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL754655600Medicaid