Healthcare Provider Details

I. General information

NPI: 1972911881
Provider Name (Legal Business Name): RYAN RUUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 600 S
ST GEORGE UT
84770-3949
US

IV. Provider business mailing address

988 E 3740 S
WASHINGTON UT
84780-1237
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-7574
  • Fax:
Mailing address:
  • Phone: 435-592-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8956091-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: