Provider Demographics
NPI:1235151531
Name:RUTHERFORD, JOY ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:ELLEN
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NE MIDWAY BLVD STE B202
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2680
Mailing Address - Country:US
Mailing Address - Phone:360-279-8220
Mailing Address - Fax:360-279-8221
Practice Address - Street 1:390 NE MIDWAY BLVD
Practice Address - Street 2:SUITE B-101
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-679-4211
Practice Address - Fax:360-279-2545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-3191405OtherEIN