Provider Demographics
NPI:1962861351
Name:RUTLEDGE, JENNIFER R (LGSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENTIA
Other - Last Name:RUTLEDGE-TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL ROAD
Mailing Address - Street 2:SOCIAL WORK SERVICE, VA CAVHCS
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:334-725-2776
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2776
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3040G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker