Provider Demographics
NPI:1407191737
Name:BRUESKE, TAMMY A (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:A
Last Name:BRUESKE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4233 113TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-9246
Mailing Address - Country:US
Mailing Address - Phone:360-359-1017
Mailing Address - Fax:360-915-8360
Practice Address - Street 1:4233 113TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-9246
Practice Address - Country:US
Practice Address - Phone:360-359-1017
Practice Address - Fax:360-915-8360
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist