=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710220603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUTH WEBB PSYD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2013
-----------------------------------------------------
Last Update Date | 03/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14225 UNIVERSITY AVE SUITE 114A
-----------------------------------------------------
City | WAUKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50263-8294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-371-9783
-----------------------------------------------------
Fax | 515-225-6680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14225 UNIVERSITY AVE SUITE 114A
-----------------------------------------------------
City | WAUKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50263-8294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-371-9783
-----------------------------------------------------
Fax | 515-225-6680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. RUTH HELEN WEBB
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 515-371-9783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 001197
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------