Provider Demographics
NPI:1437445939
Name:RUTLEDGE, LEAH (BCBA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 S BRIDGEWAY PL STE 150
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6953
Mailing Address - Country:US
Mailing Address - Phone:208-210-4442
Mailing Address - Fax:888-783-7611
Practice Address - Street 1:738 S BRIDGEWAY PL STE 150
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6953
Practice Address - Country:US
Practice Address - Phone:208-210-4442
Practice Address - Fax:888-783-7611
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst