Provider Demographics
NPI:1265105563
Name:BRUESEKE, ELIZABETH ANN (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BRUESEKE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:FLORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 LINCOLNWAY W STE T
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2063
Mailing Address - Country:US
Mailing Address - Phone:574-651-8912
Mailing Address - Fax:574-281-4412
Practice Address - Street 1:1415 LINCOLNWAY W STE T
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2063
Practice Address - Country:US
Practice Address - Phone:574-651-8912
Practice Address - Fax:574-281-4412
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health