Provider Demographics
NPI:1376987651
Name:YARUSSO, ALLISON JOAN (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JOAN
Last Name:YARUSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JOAN
Other - Last Name:AUTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:F282/2A WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-9822
Mailing Address - Fax:612-273-9779
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:F282/2A WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-9822
Practice Address - Fax:612-273-9779
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN609872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry