Provider Demographics
NPI:1700354784
Name:ADAMSON, RUTH NIELSON (LMSW-380)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:NIELSON
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:LMSW-380
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W BURNSIDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4916
Mailing Address - Country:US
Mailing Address - Phone:208-238-9000
Mailing Address - Fax:208-238-9002
Practice Address - Street 1:210 W BURNSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4916
Practice Address - Country:US
Practice Address - Phone:208-238-9000
Practice Address - Fax:208-238-9002
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health