Provider Demographics
NPI:1659071660
Name:RUTKOWSKI, KATELYNN MARIE (NCC)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MARIE
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2679
Mailing Address - Country:US
Mailing Address - Phone:865-243-7678
Mailing Address - Fax:
Practice Address - Street 1:508 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2679
Practice Address - Country:US
Practice Address - Phone:865-243-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty