Provider Demographics
NPI:1518113075
Name:BILBRUCK, KELLY CLINARD (AU)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CLINARD
Last Name:BILBRUCK
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:5830 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4311
Practice Address - Country:US
Practice Address - Phone:407-658-0228
Practice Address - Fax:407-282-5483
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 937231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist