=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699009613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUTH WITTERSGREEN PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 09/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 N AUGUSTA ST
-----------------------------------------------------
City | STAUNTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24401-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-887-6538
-----------------------------------------------------
Fax | 202-333-2525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 HENDREN AVE
-----------------------------------------------------
City | STAUNTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24401-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-887-6538
-----------------------------------------------------
Fax | 202-333-2525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RUTH WITTERSGREEN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 540-887-6538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810003439
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------