Provider Demographics
NPI:1689899536
Name:BRUTZ, LORETTA RUTH (BA MED MS)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:RUTH
Last Name:BRUTZ
Suffix:
Gender:F
Credentials:BA MED MS
Other - Prefix:MISS
Other - First Name:LORETTA
Other - Middle Name:RUTH
Other - Last Name:MCCLANAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1923
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515
Mailing Address - Country:US
Mailing Address - Phone:928-871-5020
Mailing Address - Fax:928-871-5020
Practice Address - Street 1:WRUSD #8 NAVAJO ROUTE 12
Practice Address - Street 2:WINDOW ROCK UNIFIED SCHOOL
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-810-7740
Practice Address - Fax:928-729-7630
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP0032OtherAZ DEPT OF HEALTH SERVICE
AZ649957Medicaid
C 01005913OtherAMERICAN SPEECH LANGUAGE