Provider Demographics
NPI:1174891782
Name:CYNTHIA K RUTTO, PMHNP
Entity type:Organization
Organization Name:CYNTHIA K RUTTO, PMHNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:RUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS, PMHNP
Authorized Official - Phone:503-288-1771
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4070
Mailing Address - Country:US
Mailing Address - Phone:503-288-1771
Mailing Address - Fax:188-826-1665
Practice Address - Street 1:2929 SW MULTNOMAH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4070
Practice Address - Country:US
Practice Address - Phone:503-288-1771
Practice Address - Fax:188-826-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550034NP261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health