Provider Demographics
NPI:1124367271
Name:RUSZKOWSKI, BRIGETTE MARIE (PC)
Entity type:Individual
Prefix:MRS
First Name:BRIGETTE
Middle Name:MARIE
Last Name:RUSZKOWSKI
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26018 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2458
Mailing Address - Country:US
Mailing Address - Phone:440-871-3095
Mailing Address - Fax:
Practice Address - Street 1:750 ABBE RD S
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7246
Practice Address - Country:US
Practice Address - Phone:440-323-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900344251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health