Provider Demographics
NPI:1184856528
Name:RUSCH, KAREN (LCSAC, LICS)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:RUSCH
Suffix:
Gender:F
Credentials:LCSAC, LICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POLK COUNTY PLZ
Mailing Address - Street 2:SUITE 50
Mailing Address - City:BALSAM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54810-9071
Mailing Address - Country:US
Mailing Address - Phone:715-485-8464
Mailing Address - Fax:715-485-8490
Practice Address - Street 1:100 POLK COUNTY PLZ
Practice Address - Street 2:SUITE 50
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-9071
Practice Address - Country:US
Practice Address - Phone:715-485-8464
Practice Address - Fax:715-485-8490
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1259-132101YA0400X
WI11781-135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)