1437497732 NPI number — MRS. KATHLEEN C BRUSA MS CCC SLP

Table of content: MRS. KATHLEEN C BRUSA MS CCC SLP (NPI 1437497732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437497732 NPI number — MRS. KATHLEEN C BRUSA MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUSA
Provider First Name:
KATHLEEN
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRONIN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437497732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3803B COMPUTER DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-791-3582
Provider Business Mailing Address Fax Number:
919-791-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3803B COMPUTER DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-791-3582
Provider Business Practice Location Address Fax Number:
919-791-3583
Provider Enumeration Date:
01/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  10087 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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