Provider Demographics
NPI:1407192909
Name:RUESINK, MICHELLE LANA
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LANA
Last Name:RUESINK
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 1:401 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:VOLGA
Mailing Address - State:SD
Mailing Address - Zip Code:57071-9019
Mailing Address - Country:US
Mailing Address - Phone:605-627-3058
Mailing Address - Fax:
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:VOLGA
Practice Address - State:SD
Practice Address - Zip Code:57071-9019
Practice Address - Country:US
Practice Address - Phone:605-627-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional