Provider Demographics
NPI:1043000516
Name:PRUSAKIEWICZ, SETH SANDERS
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:SANDERS
Last Name:PRUSAKIEWICZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 E MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1621
Mailing Address - Country:US
Mailing Address - Phone:989-619-2380
Mailing Address - Fax:
Practice Address - Street 1:1989 WALDEN DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8241
Practice Address - Country:US
Practice Address - Phone:989-619-2380
Practice Address - Fax:231-525-3170
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist