Provider Demographics
NPI:1235769993
Name:BRUNN, PAUL ERWIN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ERWIN
Last Name:BRUNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-9562
Mailing Address - Country:US
Mailing Address - Phone:262-607-6390
Mailing Address - Fax:
Practice Address - Street 1:93 W GENEVA ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9562
Practice Address - Country:US
Practice Address - Phone:262-607-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health