Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW09923111 | CO |
N | 1041C0700X | Clinical Social Worker | LW00004293 | WA |
NPI | 1003257015 |
---|---|
Provider Name | Deborah Jean Rutt |
First Address | Boulder, CO 80301-6734 |
Second Address | Boulder, CO 80301-6734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 08/07/2013 |