Provider Demographics
NPI:1891281580
Name:RUTLEDGE, DAVID ALEXANDER SR (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:RUTLEDGE
Suffix:SR
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4879
Mailing Address - Country:US
Mailing Address - Phone:937-610-8618
Mailing Address - Fax:
Practice Address - Street 1:2261 PHILADELPHIA DR.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-734-6763
Practice Address - Fax:937-277-7249
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.14508041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty