Provider Demographics
NPI:1487091658
Name:EMILY BARR RUTH, PSYD, LLC
Entity type:Organization
Organization Name:EMILY BARR RUTH, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:BARR
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-669-7981
Mailing Address - Street 1:702 N BLACKHAWK AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3357
Mailing Address - Country:US
Mailing Address - Phone:608-669-7981
Mailing Address - Fax:608-441-3370
Practice Address - Street 1:702 N BLACKHAWK AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-669-7981
Practice Address - Fax:608-441-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2804-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty