Basic Information
Provider Information
NPI: 1053511949
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUTH
FirstName: ERIKA
MiddleName: JACLYN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 E CHESTNUT ST UNIT 600
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402025705
CountryCode: US
TelephoneNumber: 5025884425
FaxNumber: 5025884427
Practice Location
Address1: 401 E CHESTNUT ST UNIT 610
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 40202
CountryCode: US
TelephoneNumber: 5025884450
FaxNumber: 5025889539
Other Information
ProviderEnumerationDate: 07/19/2007
LastUpdateDate: 06/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0802X45485KYY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry

No ID Information.


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