Provider Demographics
NPI:1790903300
Name:KUSKE, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:KUSKE
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 1:811 E SAINT ANDREW ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3982
Mailing Address - Country:US
Mailing Address - Phone:605-388-2163
Mailing Address - Fax:
Practice Address - Street 1:811 E SAINT ANDREW ST STE 3
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3982
Practice Address - Country:US
Practice Address - Phone:605-388-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD825101YP2500X
SDLPC-MH20261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994298OtherBLUE CROSS/BLUE SHIELD