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General NPI Number Information
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NPI Number | 1154472728
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Entity Type | Individual
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Provider Name | PENNY BRUCKER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 24024 WEST BRANCASTER DRIVE
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City | NAPERVILLE
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State | IL
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Zip | 60564
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Country | US
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Telephone | 630-809-2180
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Fax | 630-219-3664
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Provider Business Mailing Address
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Address Line | 5428 SILK OAK DRIVE
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City | NAPERVILLE
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State | IL
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Zip | 60564
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Country | US
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Telephone | 630-809-2180
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Fax | 630-219-3664
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000599
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License Number State | IL
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