Provider Demographics
NPI:1376267476
Name:RUTLEDGE, ALYSSA BROOKE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:BROOKE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BEECH CT
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2837
Mailing Address - Country:US
Mailing Address - Phone:609-204-9973
Mailing Address - Fax:
Practice Address - Street 1:232 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1907
Practice Address - Country:US
Practice Address - Phone:856-318-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01162400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist