Provider Demographics
NPI:1659997450
Name:KRUSZKA, EMERSON
Entity Type:Individual
Prefix:
First Name:EMERSON
Middle Name:
Last Name:KRUSZKA
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 1:704 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1154
Mailing Address - Country:US
Mailing Address - Phone:269-719-0996
Mailing Address - Fax:
Practice Address - Street 1:715 TERRACE ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1107
Practice Address - Country:US
Practice Address - Phone:800-644-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician