Healthcare Provider Details

I. General information

NPI: 1033980073
Provider Name (Legal Business Name): HOWARD RUAN LCSW, MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 W PETERSON AVE LBBY 2
CHICAGO IL
60659-3920
US

IV. Provider business mailing address

2714 W PETERSON AVE LBBY 2
CHICAGO IL
60659-3920
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-6092
  • Fax:
Mailing address:
  • Phone: 312-725-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149028500
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149028500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: