Provider Demographics
NPI:1174188791
Name:RUTLEDGE ANNEN, ERICA TEALE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:TEALE
Last Name:RUTLEDGE ANNEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17033 CARLTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-4606
Mailing Address - Country:US
Mailing Address - Phone:317-902-4058
Mailing Address - Fax:
Practice Address - Street 1:9783 E 116TH ST
Practice Address - Street 2:PMB 6234
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074
Practice Address - Country:US
Practice Address - Phone:317-207-6037
Practice Address - Fax:317-886-4574
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker