MEDICARE: JENNA RUSINOWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101006259	MI

General Provider Information

NPI Number	:	1982256947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA RUSINOWSKI

Provider Business Mailing Address
First Line	:	8045 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2627
Country	:	US
Telephone Number	:	313-821-3525
Fax Number	:

Provider Business Practice Location Address
First Line	:	8045 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2627
Country	:	US
Telephone Number	:	313-821-3525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	07/10/2019

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Directions to “ JENNA RUSINOWSKI ” Practice Location

Language	Start Address	Practice Location

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