Kathryn Anne Bruflat, MS-CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Pewaukee, WI

NPI 1104036409 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1104036409
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
889-154 (WI)
Practice address
321 Riverside Dr
Pewaukee, WI 53072-4612
Phone
(262) 691-2300
Fax
(262) 691-6256
NPI assigned
May 23, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
889-154WIMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 889-154 WI Yes

Addresses

Primary practice location

321 Riverside Dr
Pewaukee, WI 53072-4612

Mailing address

W330N6264 Hasslinger Dr
Nashotah, WI 53058-9732
Phone (262) 691-6262

Other identifiers

IdentifierTypeStateIssuer
42722200MedicaidWI

Other providers in Pewaukee, WI

All providers in Pewaukee, WI · Speech-Language Pathologist in Wisconsin

Sources for this page

Verify at the official NPI Registry.