Provider Demographics
NPI:1093044901
Name:KUSCH, JANICE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MARIE
Last Name:KUSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9699
Mailing Address - Country:US
Mailing Address - Phone:509-330-0255
Mailing Address - Fax:
Practice Address - Street 1:825 JADWIN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3589
Practice Address - Country:US
Practice Address - Phone:509-946-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical