Provider Demographics
NPI:1003022401
Name:BRUNE, CYNTHIA R (MS ART THERAPY)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:BRUNE
Suffix:
Gender:F
Credentials:MS ART THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 S HATLEY
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110
Mailing Address - Country:US
Mailing Address - Phone:414-294-9348
Mailing Address - Fax:
Practice Address - Street 1:5151 W SILVER SPRING E
Practice Address - Street 2:WING A3 WILLOWGLEN THERAPY ASSOCIATES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43712100Medicaid