Provider Demographics
NPI:1376629527
Name:RUSCH, KIM A (MSE)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:RUSCH
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9994 GETAWAY LN
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-8236
Mailing Address - Country:US
Mailing Address - Phone:920-321-4002
Mailing Address - Fax:
Practice Address - Street 1:410 NORTH U.S. HIGHWAY 141
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-8236
Practice Address - Country:US
Practice Address - Phone:715-330-3738
Practice Address - Fax:715-430-2243
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3255125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43565700Medicaid