Provider Demographics
NPI:1265804280
Name:RUSCH, CHERRY (MS BCABA)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:RUSCH
Suffix:
Gender:F
Credentials:MS BCABA
Other - Prefix:
Other - First Name:CHERRY
Other - Middle Name:
Other - Last Name:HAGENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCABA
Mailing Address - Street 1:304 INVERNESS WAY S STE 125
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5820
Mailing Address - Country:US
Mailing Address - Phone:303-759-1342
Mailing Address - Fax:
Practice Address - Street 1:304 INVERNESS WAY S STE 125
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-759-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-17-8354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst