Provider Demographics
NPI:1013347806
Name:PRUSA, JENNA (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PRUSA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6226
Mailing Address - Country:US
Mailing Address - Phone:515-233-2250
Mailing Address - Fax:515-233-3235
Practice Address - Street 1:513 5TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3216
Practice Address - Country:US
Practice Address - Phone:320-214-9692
Practice Address - Fax:320-214-9924
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN208001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical