Provider Demographics
NPI:1609910264
Name:RATTENBURY, RUTH M (PSYD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:M
Last Name:RATTENBURY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3013
Mailing Address - Country:US
Mailing Address - Phone:773-262-5099
Mailing Address - Fax:
Practice Address - Street 1:600 DAVIS ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4488
Practice Address - Country:US
Practice Address - Phone:847-644-3284
Practice Address - Fax:847-328-4838
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL624380Medicare ID - Type Unspecified