Provider Demographics
NPI:1689229874
Name:RUTLEDGE, BARRON E (LCSW)
Entity Type:Individual
Prefix:
First Name:BARRON
Middle Name:E
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13439 FORESTLAC DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6005
Mailing Address - Country:US
Mailing Address - Phone:614-425-2604
Mailing Address - Fax:
Practice Address - Street 1:111 PROSPECT AVE
Practice Address - Street 2:STE 201D
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6052
Practice Address - Country:US
Practice Address - Phone:614-425-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170348151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical