Individual
MRS. THERESA LYNN PETRUSKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
4795 BROADWAY, SUITE A, GARY, IN 46409-2403
(219) 980-6217
(219) 985-6772
Mailing address
3601 MISSISSIPPI ST, GARY, IN 46409-1235
(219) 718-7626
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
33007071A
IN
Other
Enumeration date
09/11/2015
Last updated
09/11/2015
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