Provider Demographics
NPI:1366201048
Name:MORGAN SPANN, RUTH ANN
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:MORGAN SPANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 N 94TH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4259
Mailing Address - Country:US
Mailing Address - Phone:623-738-9801
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR STE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4259
Practice Address - Country:US
Practice Address - Phone:623-738-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health