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NPI Code Detail

MEDICARE: DR. KIMBERLY LYNN BRUNT PH.D., H.S.P.P.

MEDICARE: DR. KIMBERLY LYNN BRUNT PH.D., H.S.P.P.
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
1103TC0700XClinical Psychologist20041373IN

General Provider Information

NPI Number : 1467449223
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY LYNN BRUNT PH.D., H.S.P.P.
Provider Business Mailing Address
First Line : 601 WALL ST
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-2512
Country : US
Telephone Number : 219-926-6977
Fax Number :
Provider Business Practice Location Address
First Line : 601 WALL ST
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-2512
Country : US
Telephone Number : 219-926-6977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 07/17/2007

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