Provider Demographics
NPI:1740388685
Name:RUTOWSKI, LISA A (LLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:RUTOWSKI
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8674 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:BEAR LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49614-9726
Mailing Address - Country:US
Mailing Address - Phone:616-935-2033
Mailing Address - Fax:
Practice Address - Street 1:269 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MI
Practice Address - Zip Code:49617-9299
Practice Address - Country:US
Practice Address - Phone:231-794-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009952103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling