Healthcare Provider Details

I. General information

NPI: 1447412838
Provider Name (Legal Business Name): STEVEN L RUOHOMAKI L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 W CRYSTAL ROCK CT UNIT 2-C
ROUND LAKE BEACH IL
60073-4642
US

IV. Provider business mailing address

1584 W CRYSTAL ROCK CT UNIT 2-C
ROUND LAKE BEACH IL
60073-4642
US

V. Phone/Fax

Practice location:
  • Phone: 847-370-9106
  • Fax:
Mailing address:
  • Phone: 847-370-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-003711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: