Provider Demographics
NPI:1104036409
Name:BRUFLAT, KATHRYN ANNE (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:BRUFLAT
Suffix:
Gender:F
Credentials:MS-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:W330N6264 HASSLINGER DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9732
Mailing Address - Country:US
Mailing Address - Phone:262-691-6262
Mailing Address - Fax:262-691-6256
Practice Address - Street 1:321 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4612
Practice Address - Country:US
Practice Address - Phone:262-691-2300
Practice Address - Fax:262-691-6256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI889-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42722200Medicaid