Provider Demographics
NPI:1386217313
Name:RUTKOWSKI, LEAH JEAN (MA, LLPC, MBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JEAN
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:MA, LLPC, MBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3328
Mailing Address - Country:US
Mailing Address - Phone:989-621-8823
Mailing Address - Fax:
Practice Address - Street 1:108 E 4TH ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1542
Practice Address - Country:US
Practice Address - Phone:989-372-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional