Provider Demographics
NPI:1346325883
Name:RUTTO, CYNTHIA KATHLEEN (RN MS PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:RUTTO
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Gender:F
Credentials:RN MS PMHNP
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Mailing Address - Street 1:2929 SW MULTNOMAH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4070
Mailing Address - Country:US
Mailing Address - Phone:503-288-1771
Mailing Address - Fax:888-261-6655
Practice Address - Street 1:3700 NW HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9708
Practice Address - Country:US
Practice Address - Phone:503-288-1771
Practice Address - Fax:888-261-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR200550034NP163WP0807X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR164936Medicaid