Individual
BRADLEY JAMES RUSOVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
56 DUKE ST, 200 WEST 'B' STREET, SUITE 226, PUEBLO, CO 81005-1604
(719) 334-1010
Mailing address
5380 PEREGRINE DR, PUEBLO, CO 81005-5521
(719) 334-1010
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC0006272
CO
Other
Enumeration date
12/02/2016
Last updated
12/02/2016
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