Glen Ruderman

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

R9085 Issued in OR

Practice address

1705 Centennial Blvd Ste 2
Springfield, OR 97477-3320

Phone

(541) 818-0009

NPI assigned

Feb 29, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oregon Directions, LLC

  • Professional Counselor
  • Springfield, OR
  • NPI 1104578350
  NPD
• Oregon Directions, LLC

  • Mental Health Counselor
  • Springfield, OR
  • NPI 1225707763
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1184481889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CENTENNIAL BLVD STE 2",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CENTENNIAL BLVD STE 2",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773320",
            "telephone_number": "541-818-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDERMAN",
        "first_name": "GLEN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R9085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Rowen
• Rency Philip Roy, M.D.
• Brenda Royce, LMT
• RSL Springfield, LLC
• Tom Ruckman, D.C., P.C.
• Kimberly Ann Ruscher, MD
• Andrew S Rushton, MD
• Holly Russell, RN, IBCLC
• Susan C Russell
• Breanna Michelle Ryan, LMT

• Mental Health Counselor in Springfield, OR
• Providers in Springfield, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.