Healthcare Provider Details

I. General information

NPI: 1972301539
Provider Name (Legal Business Name): RUTH VELEZ MSW, LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3965
US

IV. Provider business mailing address

2502 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3965
US

V. Phone/Fax

Practice location:
  • Phone: 360-831-0904
  • Fax:
Mailing address:
  • Phone: 360-831-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60334912
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60334912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: