Provider Demographics
NPI:1972774495
Name:JRS PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:JRS PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER JRS PSYCHOLOGICAL SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:5867720865
Authorized Official - Phone:586-772-0865
Mailing Address - Street 1:21200 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3209
Mailing Address - Country:US
Mailing Address - Phone:586-772-0868
Mailing Address - Fax:
Practice Address - Street 1:21200 RAVEN
Practice Address - Street 2:JRS PSYCHOLOGICAL SERVICES PC
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-772-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JRS PSYCHOLOGICAL SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E0 4506Medicare PIN
MI0E04506Medicare UPIN