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General NPI Number Information
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NPI Number | 1255052866
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Entity Type | Organization
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Legal Business Name | RUBY WAVES OF WELLNESS
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 04/15/2023
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Provider Practice Location Address
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Address Line | 105 W PRAIRIE AVE
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City | OGDEN
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State | IL
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Zip | 61859-8808
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Country | US
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Telephone | 217-274-2363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 374
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City | OGDEN
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State | IL
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Zip | 61859-0374
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Country | US
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Telephone | 217-274-2363
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | JOSIE DORTHEA MITCHELL
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Credential | LCSW
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Telephone | 765-761-3997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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