Provider Demographics
NPI:1871061887
Name:DAVIS, RUTH G (LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:E
Other - Last Name:GINGRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2712 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1402
Mailing Address - Country:US
Mailing Address - Phone:260-744-4326
Mailing Address - Fax:260-744-0188
Practice Address - Street 1:2712 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1402
Practice Address - Country:US
Practice Address - Phone:260-744-4326
Practice Address - Fax:260-744-0188
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33003263A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical