Provider Demographics
NPI:1457324626
Name:RUTTER, KEVIN CHRISTOPHER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:RUTTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:C
Other - Last Name:RUTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-0480
Mailing Address - Country:US
Mailing Address - Phone:801-647-2106
Mailing Address - Fax:
Practice Address - Street 1:443 S 600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2708
Practice Address - Country:US
Practice Address - Phone:801-538-2057
Practice Address - Fax:801-596-2515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13424435011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT695323OtherDESERET MUTUAL
UT107009854101OtherINTERMOUNTAIN HEALTH CARE