Provider Demographics
NPI:1285816694
Name:RUTLEDGE, STEPHEN CLARK (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CLARK
Last Name:RUTLEDGE
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 1:9123 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6248
Mailing Address - Country:US
Mailing Address - Phone:731-377-0088
Mailing Address - Fax:
Practice Address - Street 1:9123 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6248
Practice Address - Country:US
Practice Address - Phone:731-377-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist