Healthcare Provider Details

I. General information

NPI: 1437069143
Provider Name (Legal Business Name): DESIREE' RUTTER EDD, CALT, DT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 WINDOVER RD STE A
JONESBORO AR
72401-6009
US

IV. Provider business mailing address

1007 WINDOVER RD STE A
JONESBORO AR
72401-6009
US

V. Phone/Fax

Practice location:
  • Phone: 870-520-0646
  • Fax: 870-520-5034
Mailing address:
  • Phone: 870-520-0646
  • Fax: 870-520-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number71437
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: