Provider Demographics
NPI:1114522653
Name:RUSZKOWSKI, JUDY A
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:RUSZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5003
Mailing Address - Country:US
Mailing Address - Phone:304-723-5440
Mailing Address - Fax:
Practice Address - Street 1:501 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5003
Practice Address - Country:US
Practice Address - Phone:304-723-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator