Provider Demographics
NPI:1518378306
Name:RUSNAK, EMILY (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 MACON RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9308
Mailing Address - Country:US
Mailing Address - Phone:734-891-4151
Mailing Address - Fax:
Practice Address - Street 1:10550 MACON RD
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9308
Practice Address - Country:US
Practice Address - Phone:734-891-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003189235Z00000X
OHSP9139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist