Healthcare Provider Details

I. General information

NPI: 1285349357
Provider Name (Legal Business Name): MADELINE MAE PRUSINOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

IV. Provider business mailing address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

V. Phone/Fax

Practice location:
  • Phone: 586-501-3070
  • Fax: 248-386-5176
Mailing address:
  • Phone: 586-501-3070
  • Fax: 248-386-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: