Healthcare Provider Details

I. General information

NPI: 1477485647
Provider Name (Legal Business Name): AUTUMN R RUHR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN R ELLIS

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PROGRESS RD
HANNIBAL MO
63401-6637
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax: 573-603-1462
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025024437
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: