MEDICARE: DR. BRENDA RUTTENBERG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY60078953	WA

General Provider Information

NPI Number	:	1740210681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA RUTTENBERG PH.D.

Provider Business Mailing Address
First Line	:	5929 EVERGREEN WAY
Second Line	:	SUITE 200
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	206-617-6002
Fax Number	:	425-259-5270

Provider Business Practice Location Address
First Line	:	5929 EVERGREEN WAY
Second Line	:	SUITE 200
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	206-617-6002
Fax Number	:	425-259-5270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/20/2010

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