Individual
JENNIFER RUSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., BSL
Contact information
Practice address
920 E BALTIMORE PIKE, KENNETT SQUARE, PA 19348-1800
(610) 388-7400
Mailing address
920 E BALTIMORE PIKE, KENNETT SQUARE, PA 19348-1800
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003697
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007727350084
—
PA
Enumeration date
01/16/2018
Last updated
06/16/2018
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