Provider Demographics
NPI:1467023804
Name:BRUCE, ANNCLARK (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ANNCLARK
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 PEGRAM DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6322
Mailing Address - Country:US
Mailing Address - Phone:662-401-6150
Mailing Address - Fax:
Practice Address - Street 1:618 PEGRAM DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6322
Practice Address - Country:US
Practice Address - Phone:662-401-6150
Practice Address - Fax:662-840-7032
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA4667231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist