Provider Demographics
NPI:1336394139
Name:PRUSKOWSKI, JUSTINE JOY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:JOY
Last Name:PRUSKOWSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:JOY
Other - Last Name:LINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1615 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-6925
Mailing Address - Country:US
Mailing Address - Phone:814-937-1985
Mailing Address - Fax:
Practice Address - Street 1:1615 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6925
Practice Address - Country:US
Practice Address - Phone:814-937-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD973-SLP235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist