Amber Marie Bruning
Individual provider Active NPI Speech-Language Pathologist · Viola, IL
NPI 1578076808 · NPPES record last updated Nov 8, 2017
Key facts
- NPI
- 1578076808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146009525 (IL)
- Practice address
- 1804 17TH Ave
Viola, IL 61486-9200 - Phone
- (309) 596-2114
- NPI assigned
- Nov 8, 2017
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 146009525 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | 146009525 | IL | Yes |
Addresses
Primary practice location
1804 17TH Ave
Viola, IL 61486-9200
Mailing address
1804 17TH Ave
Viola, IL 61486-9200
Phone (309) 596-2114
Other providers in Viola, IL
All providers in Viola, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.