Provider Demographics
NPI:1780645382
Name:RUTLEDGE, SUSAN ANNETTE (MED LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNETTE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MED LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11155 DUNN RD STE 312E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6111
Mailing Address - Country:US
Mailing Address - Phone:314-953-8500
Mailing Address - Fax:314-355-1070
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:SUITE 312E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-953-8500
Practice Address - Fax:314-355-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0031961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical