Provider Demographics
NPI:1225220155
Name:WRUCK, DONALD KURT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:KURT
Last Name:WRUCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4724
Mailing Address - Country:US
Mailing Address - Phone:126-269-4965
Mailing Address - Fax:126-269-7321
Practice Address - Street 1:8815 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-4724
Practice Address - Country:US
Practice Address - Phone:126-269-4965
Practice Address - Fax:126-269-7321
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist