Provider Demographics
NPI:1710405311
Name:RUSINAK, SETA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SETA
Middle Name:
Last Name:RUSINAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 HARMONY ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-7035
Mailing Address - Country:US
Mailing Address - Phone:317-313-7783
Mailing Address - Fax:
Practice Address - Street 1:122 E OLIN AVE STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1482
Practice Address - Country:US
Practice Address - Phone:608-255-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2017-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009519103TC0700X
WI3472-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical