Provider Demographics
NPI:1629623178
Name:BRUCE, ILANA SARA-MAE (MT-BC)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:SARA-MAE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N DOBSON RD STE F-2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-9611
Mailing Address - Country:US
Mailing Address - Phone:480-722-1300
Mailing Address - Fax:
Practice Address - Street 1:3200 N DOBSON RD STE F-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9611
Practice Address - Country:US
Practice Address - Phone:480-722-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist