Provider Demographics
NPI:1174492425
Name:DE BRUYN, JADYN STEPHANIE
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:STEPHANIE
Last Name:DE BRUYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:DE BRUYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1943 LAUREL WOOD CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1208
Mailing Address - Country:US
Mailing Address - Phone:805-443-4222
Mailing Address - Fax:
Practice Address - Street 1:100 N LAKEVIEW CANYON RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3802
Practice Address - Country:US
Practice Address - Phone:805-497-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71B66CDF53171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach