Provider Demographics
NPI:1356679054
Name:BRUCKNER, MARY JO STARCK (MS, CCC-SP)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:STARCK
Last Name:BRUCKNER
Suffix:
Gender:F
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 E MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4737
Mailing Address - Country:US
Mailing Address - Phone:206-484-7723
Mailing Address - Fax:
Practice Address - Street 1:4909 E MERCER WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4737
Practice Address - Country:US
Practice Address - Phone:206-484-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist