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General NPI Number Information
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NPI Number | 1720201080
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Entity Type | Individual
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Provider Name | SHIRLEY M. RUTHERFORD M.A., LP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7515 WAYZATA BLVD #212
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-1604
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Country | US
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Telephone | 952-544-0300
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Fax | 952-544-0301
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Provider Business Mailing Address
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Address Line | 1200 NICOLLET AVE #416
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-2400
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Country | US
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Telephone | 612-333-1385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3153
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License Number State | MN
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