Provider Demographics
NPI:1831776079
Name:GRUSECKI, KATELYN MARY (PSY D)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARY
Last Name:GRUSECKI
Suffix:
Gender:F
Credentials:PSY D
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Mailing Address - Street 1:301 TROY DR
Mailing Address - Street 2:ADMINISTRATION BUILDING
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1521
Mailing Address - Country:US
Mailing Address - Phone:608-301-1045
Mailing Address - Fax:608-301-1390
Practice Address - Street 1:301 TROY DR
Practice Address - Street 2:ADMINISTRATION BUILDING
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1521
Practice Address - Country:US
Practice Address - Phone:608-301-1045
Practice Address - Fax:608-301-1390
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3848-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3848-57OtherDEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES