Provider Demographics
NPI:1790493351
Name:RUSCO, HAYLEY MORGAN (LLMSW)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:MORGAN
Last Name:RUSCO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:MORGAN
Other - Last Name:STITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:528 3 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3345
Mailing Address - Country:US
Mailing Address - Phone:616-216-4421
Mailing Address - Fax:
Practice Address - Street 1:333 BRIDGE ST NW STE 1120
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5356
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511100731041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical