1962861351 NPI number — JENNIFER R. RUTLEDGE LGSW

Table of content: JENNIFER R. RUTLEDGE LGSW (NPI 1962861351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962861351 NPI number — JENNIFER R. RUTLEDGE LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTLEDGE
Provider First Name:
JENNIFER
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUTLEDGE-TALLEY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RENTIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962861351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 HOSPITAL ROAD
Provider Second Line Business Mailing Address:
SOCIAL WORK SERVICE, VA CAVHCS
Provider Business Mailing Address City Name:
TUSKEGEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-727-0550
Provider Business Mailing Address Fax Number:
334-725-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSKEGEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36083-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-727-0550
Provider Business Practice Location Address Fax Number:
334-725-2776
Provider Enumeration Date:
02/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  3040G , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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