Provider Demographics
NPI:1164473989
Name:RUTTENBURG, BRUCE JAFFEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAFFEE
Last Name:RUTTENBURG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1210
Mailing Address - Country:US
Mailing Address - Phone:541-387-6138
Mailing Address - Fax:541-387-6148
Practice Address - Street 1:814 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1210
Practice Address - Country:US
Practice Address - Phone:541-387-6138
Practice Address - Fax:541-387-6148
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1674103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist