Healthcare Provider Details

I. General information

NPI: 1003257015
Provider Name (Legal Business Name): DEBORAH JEAN RUTT PHD, LCSW, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5946 GUNBARREL AVE UNIT B
BOULDER CO
80301-6734
US

IV. Provider business mailing address

5946 GUNBARREL AVE UNIT B
BOULDER CO
80301-6734
US

V. Phone/Fax

Practice location:
  • Phone: 303-506-8177
  • Fax:
Mailing address:
  • Phone: 303-506-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09923111
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004293
License Number StateWA

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: