MEDICARE: DANIELLE ALEXANDRA BRUENINGSEN MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	27351	CA

General Provider Information

NPI Number	:	1053892810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ALEXANDRA BRUENINGSEN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	315 HOLMWOOD DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4115
Country	:	US
Telephone Number	:	610-984-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E WASHINGTON AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-3843
Country	:	US
Telephone Number	:	610-984-5462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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