Individual
MISS TAEDRA MARIE RUTLIN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA PLPC
Contact information
Practice address
14377 WOOD LAKE DRIVE, SUITE 308, CHESTERFIELD, MO 63017
(314) 576-6493
(314) 576-7319
Mailing address
875 LIBERTY VILLAGE DR, FLORISSANT, MO 63031
(314) 838-1545
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2002017415
MO
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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