Healthcare Provider Details

I. General information

NPI: 1245913359
Provider Name (Legal Business Name): JONATHAN EMMANUEL RUIZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

99 S 17TH ST
KANSAS CITY KS
66102-4946
US

V. Phone/Fax

Practice location:
  • Phone: 816-889-4642
  • Fax: 816-889-1838
Mailing address:
  • Phone: 913-961-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14492
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023031829
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: