Provider Demographics
NPI:1073779039
Name:CRUZ, BRITTANY JEA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:JEA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SALTCEDAR CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-7582
Mailing Address - Country:US
Mailing Address - Phone:217-679-2789
Mailing Address - Fax:
Practice Address - Street 1:1505 SALTCEDAR CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712-7582
Practice Address - Country:US
Practice Address - Phone:217-679-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist