Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 071008927 | IL |
NPI | 1053799015 |
---|---|
Provider Name | Dr. Dana Rusch |
First Address | Chicago, IL 60622-6985 |
Second Address | Chicago, IL 60608-1264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 11/05/2015 |