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General NPI Number Information
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NPI Number | 1932744067
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Entity Type | Individual
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Provider Name | SARA RUIZ
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Gender | Female
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | CLOCK TOWER OFFICE PARK, 6333 ODANA RD #20
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-270-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N BREARLY ST APT 4
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City | MADISON
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State | WI
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Zip | 53703-2354
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Country | US
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Telephone | 920-471-9743
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | WI
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