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General NPI Number Information
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NPI Number | 1760673909
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Entity Type | Individual
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Provider Name | KAREN MARIE RUSNIAK PHD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 7300 DIXIE HWY STE 1000
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City | CLARKSTON
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State | MI
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Zip | 48346-5105
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Country | US
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Telephone | 248-922-2300
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Fax | 248-922-2304
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Provider Business Mailing Address
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Address Line | 3792 N CENTURY OAK CIR
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City | OAKLAND
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State | MI
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Zip | 48363-2666
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Country | US
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Telephone | 586-354-7788
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301011919
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License Number State | MI
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