Provider Demographics
NPI:1184501256
Name:RUTLEDGE, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SE SHADY LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-5503
Mailing Address - Country:US
Mailing Address - Phone:541-580-4109
Mailing Address - Fax:
Practice Address - Street 1:1409 NE DIAMOND LAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3356
Practice Address - Country:US
Practice Address - Phone:541-440-4777
Practice Address - Fax:541-440-4771
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1017546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist