Provider Demographics
NPI:1407089899
Name:RUSNAK MILLER, GRETCHEN L (LSW, MSSA)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:L
Last Name:RUSNAK MILLER
Suffix:
Gender:F
Credentials:LSW, MSSA
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:RUSNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSSA
Mailing Address - Street 1:6370 WISE AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7350
Mailing Address - Country:US
Mailing Address - Phone:330-818-0678
Mailing Address - Fax:
Practice Address - Street 1:6370 WISE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7350
Practice Address - Country:US
Practice Address - Phone:330-818-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08003701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical