Provider Demographics
NPI:1821711672
Name:PRUSHEK, SEPTEMBER AURORA
Entity Type:Individual
Prefix:
First Name:SEPTEMBER
Middle Name:AURORA
Last Name:PRUSHEK
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 1:23684 COUNTY ROAD 4 # CABIN5
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2230
Mailing Address - Country:US
Mailing Address - Phone:218-838-2043
Mailing Address - Fax:
Practice Address - Street 1:13782 BLUESTEM CT STE 100
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8768
Practice Address - Country:US
Practice Address - Phone:218-833-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health