Provider Demographics
NPI:1679718860
Name:RUTHERFORD, SUSAN LESLIE (MSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LESLIE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3317
Mailing Address - Country:US
Mailing Address - Phone:541-345-5490
Mailing Address - Fax:541-343-2011
Practice Address - Street 1:401 E 10TH AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3317
Practice Address - Country:US
Practice Address - Phone:541-345-5490
Practice Address - Fax:541-343-2011
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL00351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical