Provider Demographics
NPI:1518084938
Name:RUSINAK, JEAN ANN KLEIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANN KLEIN
Last Name:RUSINAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-5000
Mailing Address - Country:US
Mailing Address - Phone:320-234-4610
Mailing Address - Fax:320-234-4652
Practice Address - Street 1:1095 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5000
Practice Address - Country:US
Practice Address - Phone:320-234-4610
Practice Address - Fax:320-234-4652
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4939103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent