Provider Demographics
NPI:1427232248
Name:RUTLEDGE, VIKKI LYNN
Entity type:Individual
Prefix:
First Name:VIKKI
Middle Name:LYNN
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 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9452
Mailing Address - Fax:909-421-4214
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9452
Practice Address - Fax:909-421-4214
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2024-06-24
Deactivation Date:2024-02-23
Deactivation Code:
Reactivation Date:2024-06-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist