Provider Demographics
NPI:1255155024
Name:RUTLEDGE, LAUREN MICHELLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELLE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 E CLARK RD STE 360-B
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7930
Mailing Address - Country:US
Mailing Address - Phone:517-507-5565
Mailing Address - Fax:
Practice Address - Street 1:1161 E CLARK RD STE 360-B
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7930
Practice Address - Country:US
Practice Address - Phone:517-507-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst