Provider Demographics
NPI:1932376530
Name:RUTKOWSKI, AUBREY ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:ELIZABETH
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:AUBREY
Other - Middle Name:ELIZABETH
Other - Last Name:JPHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2647 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1736
Mailing Address - Country:US
Mailing Address - Phone:586-480-3636
Mailing Address - Fax:
Practice Address - Street 1:42669 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5036
Practice Address - Country:US
Practice Address - Phone:586-412-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1244192104100000X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool