Provider Demographics
NPI:1275670911
Name:BRUNDAGE, JANICE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:KAY
Last Name:BRUNDAGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4646
Mailing Address - Country:US
Mailing Address - Phone:520-325-8500
Mailing Address - Fax:520-325-3424
Practice Address - Street 1:3861 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4646
Practice Address - Country:US
Practice Address - Phone:520-325-8500
Practice Address - Fax:520-325-3424
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist