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NPI Code Detail

MEDICARE: DR. CYNTHIA RUTLEDGE ED.D., CACIII

MEDICARE: DR. CYNTHIA RUTLEDGE ED.D., CACIII
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) Psychologist1655CO

General Provider Information

NPI Number : 1558767764
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYNTHIA RUTLEDGE ED.D., CACIII
Provider Business Mailing Address
First Line : 255 CANYON BLVD STE 300
Second Line :
City : BOULDER
State : CO
Zip : 80302-4954
Country : US
Telephone Number : 303-842-2159
Fax Number : 303-444-0646
Provider Business Practice Location Address
First Line : 255 CANYON BLVD STE 300
Second Line :
City : BOULDER
State : CO
Zip : 80302-4954
Country : US
Telephone Number : 303-842-2159
Fax Number : 303-444-0646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2014
Last Update Date : 11/16/2014

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