Healthcare Provider Details

I. General information

NPI: 1881999829
Provider Name (Legal Business Name): BETH RUTKOWSKI L.P., C.A.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

1247 WOODWARD AVE APT 1010
DETROIT MI
48226-2025
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-0636
  • Fax:
Mailing address:
  • Phone: 734-395-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberC-02694
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: