Individual
MR. CODY NEAL RUTKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
4747 MONROE ST, TOLEDO, OH 43623-4307
(419) 740-5079
Mailing address
4747 MONROE ST, TOLEDO, OH 43623-4307
(419) 740-5079
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.179899
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
I DON'T HAVE A MEDICAID NUMBER AT THIS TIME
—
Enumeration date
05/23/2022
Last updated
05/23/2022
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