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General NPI Number Information
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NPI Number | 1043553423
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Entity Type | Individual
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Provider Name | RUTH ALICIA SOBECK MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 757 S MAIN ST SUITE 8
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City | FOND DU LAC
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State | WI
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Zip | 54935-5708
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1057-124
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License Number State | WI
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