Healthcare Provider Details

I. General information

NPI: 1558767764
Provider Name (Legal Business Name): CYNTHIA RUTLEDGE ED.D., CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 11/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CANYON BLVD STE 300
BOULDER CO
80302-4954
US

IV. Provider business mailing address

255 CANYON BLVD STE 300
BOULDER CO
80302-4954
US

V. Phone/Fax

Practice location:
  • Phone: 303-842-2159
  • Fax: 303-444-0646
Mailing address:
  • Phone: 303-842-2159
  • Fax: 303-444-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1655
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: