Individual
MS. JEAN MARIE PRUSCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC, ICS
Contact information
Practice address
840 LAKE AVE, SUITE 101, RACINE, WI 53403-1566
(262) 634-8688
(262) 634-7547
Mailing address
N3157 WILLIAMS ST, LAKE GENEVA, WI 53147-3532
(262) 249-0382
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11083-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39389200
—
WI
Enumeration date
03/06/2007
Last updated
07/09/2007
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