Provider Demographics
NPI:1689900128
Name:RUTLEDGE, LAURA CAITLIN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CAITLIN
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0636
Mailing Address - Country:US
Mailing Address - Phone:231-286-8546
Mailing Address - Fax:
Practice Address - Street 1:7733 EMBERLY DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9166
Practice Address - Country:US
Practice Address - Phone:231-286-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010884331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty