Basic Information
| Provider Information | |||||||||
| NPI: | 1790493351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSCO | ||||||||
| FirstName: | HAYLEY | ||||||||
| MiddleName: | MORGAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LLMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STITES | ||||||||
| OtherFirstName: | HAYLEY | ||||||||
| OtherMiddleName: | MORGAN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LLMSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 528 3 MILE RD NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495053345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162164421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 BRIDGE ST NW STE 1120 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495045356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168053660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2022 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6851110073 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 6851110073 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.