Healthcare Provider Details

I. General information

NPI: 1487965521
Provider Name (Legal Business Name): JENNIFER RENAE DOWNEY-RUTLEDGE M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER RENAE DOWNEY

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12406 HIGHWAY 5 STE C
CABOT AR
72023-7657
US

IV. Provider business mailing address

20 SUN VALLEY DR
CABOT AR
72023-2056
US

V. Phone/Fax

Practice location:
  • Phone: 501-231-5544
  • Fax:
Mailing address:
  • Phone: 501-231-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2206011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: