Provider Demographics
NPI:1437940392
Name:RUTH, CORY (MS, RDN)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-0367
Mailing Address - Country:US
Mailing Address - Phone:415-361-0522
Mailing Address - Fax:
Practice Address - Street 1:1756 PAIR A DICE RANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9238
Practice Address - Country:US
Practice Address - Phone:415-361-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87-1628335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered