| NPI | 1700478625 |
|---|---|
| Former Name | CARLY CRISTINE RUTTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN 3936) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 305956) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2023-07-03 |