Basic Information
| Provider Information | |||||||||
| NPI: | 1396972899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTHERFORD | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5982 RHODES RD | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306731347 | ||||||||
| FaxNumber: | 3306783677 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447022044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304382400 | ||||||||
| FaxNumber: | 3304383003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 06/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I.0600059-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.