Basic Information
| Provider Information | |||||||||
| NPI: | 1518128214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTLEDGE | ||||||||
| FirstName: | BROOK | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 SE 168TH AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986832101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605931889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3550 SE WOODWARD ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972021552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035178663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 02/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.