Provider Demographics
NPI:1518530120
Name:RUSIECKI, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RUSIECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W PINNACLE PEAK RD UNIT 110B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1247
Mailing Address - Country:US
Mailing Address - Phone:480-210-8244
Mailing Address - Fax:
Practice Address - Street 1:2095 W PINNACLE PEAK RD UNIT 110B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1247
Practice Address - Country:US
Practice Address - Phone:480-210-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician