Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 7079 | CO |
NPI | 1114222320 |
---|---|
Provider Name | Dr. Ilene Naomi Rusk |
First Address | Boulder, CO 80304-4240 |
Second Address | Boulder, CO 80304-4240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2011 |
Last Update Date | 17/06/2015 |