Provider Demographics
NPI:1801168372
Name:GRUSZYNSKI, SARITA LOUISE (CAPSW)
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:LOUISE
Last Name:GRUSZYNSKI
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:SARITA
Other - Middle Name:LOUISE
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:54177-9719
Mailing Address - Country:US
Mailing Address - Phone:715-856-6677
Mailing Address - Fax:
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128557121104100000X
MI68010941131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker