Provider Demographics
NPI:1396508412
Name:RUTTENCUTTER, AIVRI NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:AIVRI
Middle Name:NICOLE
Last Name:RUTTENCUTTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43910-7720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 ANTHONI AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6403
Practice Address - Country:US
Practice Address - Phone:304-242-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-319679106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician