Individual
DR. EDWARD BAXTER RUSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
7009 CRYSTAL SPRINGS ROAD, CRYSTAL LAKE, IL 60012-1154
(815) 455-7333
(815) 477-0821
Mailing address
7009 CRYSTAL SPRINGS ROAD, CRYSTAL LAKE, IL 60012-1154
(815) 455-7333
(815) 477-0821
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5672007
BC BS
IL
Enumeration date
02/05/2007
Last updated
07/08/2007
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