Ruth E Raeber

Individual provider Active NPI Developmental Therapist · Gillespie, IL

NPI 1396868055 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1396868055
Entity type
Individual (NPI type 1)
Primary specialty
Developmental Therapist 222Q00000X
Practice address
10247 Columbey Dr
Gillespie, IL 62033-2250
Phone
(217) 839-4705
Fax
(217) 839-4705
NPI assigned
Apr 9, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X Yes

Addresses

Primary practice location

10247 Columbey Dr
Gillespie, IL 62033-2250

Mailing address

PO Box 326
Jerseyville, IL 62052-0326
Phone (618) 946-0374

Other providers in Gillespie, IL

All providers in Gillespie, IL · Developmental Therapist in Illinois

Sources for this page

Verify at the official NPI Registry.