Provider Demographics
NPI:1447768304
Name:HRUSCHAK, JEAN M (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:HRUSCHAK
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 TAMWORTH CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1739
Mailing Address - Country:US
Mailing Address - Phone:614-746-8390
Mailing Address - Fax:614-746-8390
Practice Address - Street 1:6342 TAMWORTH CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1739
Practice Address - Country:US
Practice Address - Phone:614-746-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
OH2933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01018758OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
OH2933OtherSPEECH PATHOLOGY LICENSE