Alysa Ann Ruddell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY1268 Issued in WA

Practice address

801 South 336 St.
Federal Way, WA 98003-6310

Phone

(253) 874-5319

Fax

(253) 838-5586

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Federal Way Psychology Clinic

  • Clinical Psychologist
  • Federal Way, WA
  • NPI 1962674010
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841385374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SOUTH 336 ST.",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036310",
            "telephone_number": "253-874-5319",
            "fax_number": "253-838-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SOUTH 336 ST.",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036310",
            "telephone_number": "253-874-5319",
            "fax_number": "253-838-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDELL",
        "first_name": "ALYSA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PSY1268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST/CHAMPUS",
            "identifier": "33375",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7070121",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE PROVIDER",
            "identifier": "947416",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "RU7443",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIM'S FUND",
            "identifier": "11597",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Royal Havens LLC Dba Royal Havens Home Health
• Kristen L Royal, LMFT
• Stephanie Royer-Artuso
• Christy Rowell Rozell, LPN
• Ji Seo Ru, NP
• Edward Rudnev, DO
• Karen Marie Ruhl, CNM
• Marisol G Ruiz Dominguez
• Dominick Andrew Ruiz, MD
• Jeremy Ruiz

• Clinical Psychologist in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.