Healthcare Provider Details

I. General information

NPI: 1982754420
Provider Name (Legal Business Name): PEGGY S. RUUD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 N. FINE STREET, SUITE 114 HOURGLASS BUILDING
FRESNO CA
93727
US

IV. Provider business mailing address

1443 N VAGEDES AVE
FRESNO CA
93728-1411
US

V. Phone/Fax

Practice location:
  • Phone: 559-312-6553
  • Fax: 559-453-2420
Mailing address:
  • Phone: 559-312-6553
  • Fax: 559-453-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: