Provider Demographics
NPI:1508376476
Name:RUTKIE, RACHEL E (QMHP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:RUTKIE
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 S HAMILTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4382
Mailing Address - Country:US
Mailing Address - Phone:614-751-0042
Mailing Address - Fax:
Practice Address - Street 1:236 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015
Practice Address - Country:US
Practice Address - Phone:740-417-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health