Healthcare Provider Details

I. General information

NPI: 1003022401
Provider Name (Legal Business Name): CYNTHIA R BRUNE MS ART THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 W SILVER SPRING E WING A3 WILLOWGLEN THERAPY ASSOCIATES
MILWAUKEE WI
53218
US

IV. Provider business mailing address

4851 S HATLEY
CUDAHY WI
53110
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-6970
  • Fax: 414-527-6971
Mailing address:
  • Phone: 414-294-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: