Active NPI
Shawn Rutledge, PSY.D.
- Clinical Psychologist
- San Luis Obispo, CA
National Provider Identifier
1669738944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY24735
- Practice address
- 8101 Hwy 1
Psych Admin
San Luis Obispo, CA 93403-8101 - Phone
- (805) 547-7900
- Fax
- (805) 547-7469
- NPI assigned
- Apr 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY24735 | CA | Primary |
Addresses
Primary practice location
8101 Hwy 1
Psych Admin
San Luis Obispo, CA 93403-8101
Mailing address
PO Box 8101
Psych Admin
San Luis Obispo, CA 93403-8101
Phone (805) 547-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24735 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1669738944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8101",
"address_2": "PSYCH ADMIN",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934038101",
"telephone_number": "805-547-7900",
"fax_number": "805-547-7469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8101 HWY 1",
"address_2": "PSYCH ADMIN",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934038101",
"telephone_number": "805-547-7900",
"fax_number": "805-547-7469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTLEDGE",
"first_name": "SHAWN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-11",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY24735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.