Nicole Susanne Ruttenberg, MS, LMFTA

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

61073067 Issued in WA

Practice address

17129 32ND Ave NE
Lake Forest Park, WA 98155-5323

Phone

(206) 850-6439

NPI assigned

Aug 8, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596844800000",
    "number": "1497365969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17129 32ND AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555323",
            "telephone_number": "206-850-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17129 32ND AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555323",
            "telephone_number": "206-850-6439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTTENBERG",
        "first_name": "NICOLE",
        "middle_name": "SUSANNE",
        "credential": "MS, LMFTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-08",
        "last_updated": "2020-08-08",
        "certification_date": "2020-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "61073067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esther Ra, D.D.S.
• Sherill Xinni Ren, M.ED., M.A.
• Robert R. Uhlmansiek, D.D.S., P.S.
• Jeanette Rodriguez, MFCC
• Molly Roklen
• Laura Sandusky
• Jessica Sather, LMFTA
• Andrea Eva Schommer, PHARM D.
• Zachary Shaeffer, LICSW
• Gwendolyn Kathleen Shattuck, LMT

• Marriage & Family Therapist in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.