Provider Demographics
NPI:1043460082
Name:RUTLAND, ELISABETH E (SLP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:E
Last Name:RUTLAND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3600 HILLCROSS DR
Mailing Address - Street 2:APT. 8
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-4614
Mailing Address - Country:US
Mailing Address - Phone:606-344-1755
Mailing Address - Fax:
Practice Address - Street 1:3600 HILLCROSS DR
Practice Address - Street 2:APT. 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4614
Practice Address - Country:US
Practice Address - Phone:606-344-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-08-059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist