MEDICARE: MRS. RUTH L KOOIMAN LP

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	103T00000X	Psychologist	LP2939	MN

General Provider Information

NPI Number	:	1720080765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH L KOOIMAN LP

Provider Business Mailing Address
First Line	:	400 S SYCAMORE AVE
Second Line	:	STE 105-3
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-1246
Country	:	US
Telephone Number	:	605-334-3739
Fax Number	:	605-334-7752

Provider Business Practice Location Address
First Line	:	215 N CEDAR ST
Second Line	:	BETHESDA CHRISTIAN COUNSELING
City	:	LUVERNE
State	:	MN
Zip	:	56156-1626
Country	:	US
Telephone Number	:	800-463-4005
Fax Number	:	605-334-7752

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	11/30/2016

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