Provider Demographics
NPI:1518167782
Name:RUSHLAU, IAN DOUGLAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DOUGLAS
Last Name:RUSHLAU
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CINNAMON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1869
Mailing Address - Country:US
Mailing Address - Phone:610-265-3836
Mailing Address - Fax:
Practice Address - Street 1:131 CINNAMON HILL RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1869
Practice Address - Country:US
Practice Address - Phone:610-265-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist