Provider Demographics
NPI:1396360558
Name:RUSK, SHELBY JAE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JAE
Last Name:RUSK
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 1:19 HICKORY LN E
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-7603
Mailing Address - Country:US
Mailing Address - Phone:765-376-2523
Mailing Address - Fax:
Practice Address - Street 1:200 E COLLEGE ST STE L1
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-2550
Practice Address - Country:US
Practice Address - Phone:765-376-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker