Provider Demographics
NPI:1588823991
Name:BRUZ, WENDY S (MA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:BRUZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 S. SAGINAW STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-695-4520
Mailing Address - Fax:810-695-4573
Practice Address - Street 1:7550 S. SAGINAW STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-695-4520
Practice Address - Fax:810-695-4573
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health