Provider Demographics
NPI:1093875544
Name:BRUSS, SANDRA E
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:BRUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:M JULIE
Other - Middle Name:
Other - Last Name:BRUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC-S, LCDC III
Mailing Address - Street 1:13000 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9337
Mailing Address - Country:US
Mailing Address - Phone:440-226-9144
Mailing Address - Fax:
Practice Address - Street 1:13000 AUBURN RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9337
Practice Address - Country:US
Practice Address - Phone:440-226-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)