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General NPI Number Information
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NPI Number | 1932224052
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Entity Type | Individual
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Provider Name | JAMES CHARLES BRUCE JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1023 BURLINGTON AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1516
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Country | US
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Telephone | 708-354-0826
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Fax | 708-354-0867
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Provider Business Mailing Address
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Address Line | 1109 WESLEY AVE
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City | OAK PARK
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State | IL
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Zip | 60304-2021
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071004983
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License Number State | IL
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