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General NPI Number Information
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NPI Number | 1093271371
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Entity Type | Individual
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Provider Name | JESSICA BRUNY
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Gender | Female
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 1307 S SHORE DR
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City | WORTHINGTON
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State | MN
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Zip | 56187-1344
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Country | US
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Telephone | 507-376-3175
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Fax |
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Provider Business Mailing Address
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Address Line | 501 MIDWOOD ST APT 2R
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City | BROOKLYN
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State | NY
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Zip | 11225-4551
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Country | US
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Telephone | 347-251-4114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 022218
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License Number State | NY
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