Provider Demographics
NPI:1720458409
Name:RUTLEDGE, TAHNOQUA (LMSW)
Entity type:Individual
Prefix:
First Name:TAHNOQUA
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N WOODLAWN ST
Mailing Address - Street 2:102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3646
Mailing Address - Country:US
Mailing Address - Phone:316-651-1226
Mailing Address - Fax:316-652-2590
Practice Address - Street 1:555 N WOODLAWN ST
Practice Address - Street 2:102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3646
Practice Address - Country:US
Practice Address - Phone:316-651-1226
Practice Address - Fax:316-652-2590
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9572104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker