Provider Demographics
NPI:1982734562
Name:KRUSKY, COLLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:KRUSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 PATRICIA CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2647
Mailing Address - Country:US
Mailing Address - Phone:517-787-7920
Mailing Address - Fax:517-787-2440
Practice Address - Street 1:330 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2121
Practice Address - Country:US
Practice Address - Phone:517-787-7920
Practice Address - Fax:517-787-2440
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health