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General NPI Number Information
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NPI Number | 1578194486
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Entity Type | Organization
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Legal Business Name | DR BETH RUTKOWSKI, LP PLLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 45555 TOURNAMENT DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-8476
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Country | US
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Telephone | 734-395-5622
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Fax |
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Provider Business Mailing Address
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Address Line | 45555 TOURNAMENT DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-8476
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Country | US
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Telephone | 734-395-5622
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BETH ANNE RUTKOWSKI
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Credential | LP
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Telephone | 734-395-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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