Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1655 | CO |
NPI | 1558767764 |
---|---|
Provider Name | Dr. Cynthia Rutledge |
First Address | Boulder, CO 80302-4954 |
Second Address | Boulder, CO 80302-4954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2014 |
Last Update Date | 16/11/2014 |