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General NPI Number Information
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NPI Number | 1245189455
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Entity Type | Individual
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Provider Name | SHEREE RUTH
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Gender | Female
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 11560 S KEDZIE AVE STE 200
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City | MERRIONETTE PARK
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State | IL
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Zip | 60803-4517
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Country | US
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Telephone | 773-590-3947
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 403
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City | OAK LAWN
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State | IL
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Zip | 60454-0403
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Country | US
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Telephone | 773-590-3947
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | IL
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