Provider Demographics
NPI:1346551298
Name:BRUNDAGE, JESSICA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
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 1:5000 W NATIONAL AVE
Mailing Address - Street 2:ZABLOCKI VAMC-SPINAL CORD INJURY SERVICE-128
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-382-5293
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:ZABLOCKI VAMC-SPINAL CORD INJURY-128
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-382-5293
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist