Provider Demographics
NPI:1548208499
Name:BRUDERECK, MINDY KATE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:KATE
Last Name:BRUDERECK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:KATE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 VAN REED RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1799
Mailing Address - Country:US
Mailing Address - Phone:610-404-8025
Mailing Address - Fax:610-404-8045
Practice Address - Street 1:560 VAN REED RD STE 205
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1799
Practice Address - Country:US
Practice Address - Phone:610-404-8025
Practice Address - Fax:610-404-8045
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6084244OtherCIGNA
PA2773101000OtherINDEPENDENCE BLUE CROSS
PABR1902248OtherHIGHMARK BLUE SHIELD
PA1351615OtherAETNA
PAP00347618OtherRAILROAD MEDICARE
PAP00347618OtherRAILROAD MEDICARE