MEDICARE: RUTH B GRAMBUSH LAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist		MN
2	171M00000X	Case Manager/Care Coordinator
3	106H00000X	Marriage & Family Therapist	4095	MN

General Provider Information

NPI Number	:	1609299619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH B GRAMBUSH LAMFT

Provider Business Mailing Address
First Line	:	3410 BOULDER TRL
Second Line	:
City	:	WEBSTER
State	:	MN
Zip	:	55088-3310
Country	:	US
Telephone Number	:	651-395-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 BOULDER TRL
Second Line	:
City	:	WEBSTER
State	:	MN
Zip	:	55088-3310
Country	:	US
Telephone Number	:	651-395-1791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/20/2021

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