Provider Demographics
NPI:1134704638
Name:RUTLEDGE, KATHERINE (CLC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 NE FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3320
Mailing Address - Country:US
Mailing Address - Phone:408-314-1184
Mailing Address - Fax:
Practice Address - Street 1:3828 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3320
Practice Address - Country:US
Practice Address - Phone:408-314-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN