Provider Demographics
NPI:1750989950
Name:MASON, RUTHELLEN LOUISE (RBA)
Entity type:Individual
Prefix:
First Name:RUTHELLEN
Middle Name:LOUISE
Last Name:MASON
Suffix:
Gender:F
Credentials:RBA
Other - Prefix:
Other - First Name:RUTHELLEN
Other - Middle Name:LOUISE
Other - Last Name:PRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBA
Mailing Address - Street 1:133 TIPPENS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-7258
Mailing Address - Country:US
Mailing Address - Phone:304-488-9447
Mailing Address - Fax:
Practice Address - Street 1:3702 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6333
Practice Address - Country:US
Practice Address - Phone:304-485-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator