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General NPI Number Information
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NPI Number | 1073548178
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Entity Type | Individual
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Provider Name | SUE ANN KURUZOVICH MSSW
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 EAST VETERANS STREET VAMC TOMAH
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City | TOMAH
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State | WI
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Zip | 54660
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Country | US
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Telephone | 608-372-1798
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Fax |
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Provider Business Mailing Address
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Address Line | 10739 STATE HIGHWAY 27
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City | SPARTA
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State | WI
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Zip | 54656-4751
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Country | US
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Telephone | 608-269-0362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6951-123
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License Number State | WI
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