Individual
DR. SHANA J. RUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD CCC-SLP
Contact information
Practice address
412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
(616) 780-0590
(616) 984-4559
Mailing address
412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
(616) 780-0590
(616) 984-4559
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301013545
MI
103T00000X
Psychologist
6301013545
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301013545
COMMERCIAL
—
Enumeration date
10/16/2009
Last updated
05/12/2023
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