Provider Demographics
NPI:1598792798
Name:BRUCE, PETER (AUD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BRUCE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2129
Mailing Address - Country:US
Mailing Address - Phone:814-860-2377
Mailing Address - Fax:814-860-2570
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-860-2377
Practice Address - Fax:814-860-2570
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000722L231H00000X
PASL003794L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist