MEDICARE: SUZANNE M RUTTI

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	I.0800234-SUPV	OH

General Provider Information

NPI Number	:	1770852303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE M RUTTI

Provider Business Mailing Address
First Line	:	1200 WEST FIFTH AVENUE, SUITE 102-D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212
Country	:	US
Telephone Number	:	614-398-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W 5TH AVE STE 102D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2503
Country	:	US
Telephone Number	:	614-398-1927
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	SUZANNE M RUTTI
Credential	:	MSW, LISW-S
Telephone Number	:	614-398-1927

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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Directions to “SUZANNE M RUTTI ” Practice Location

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