Provider Demographics
NPI:1720201080
Name:RUTHERFORD, SHIRLEY M (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:M
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NICOLLET AVE
Mailing Address - Street 2:#416
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2400
Mailing Address - Country:US
Mailing Address - Phone:612-333-1385
Mailing Address - Fax:
Practice Address - Street 1:7515 WAYZATA BLVD
Practice Address - Street 2:#212
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1604
Practice Address - Country:US
Practice Address - Phone:952-544-0300
Practice Address - Fax:952-544-0301
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3153103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling