Provider Demographics
NPI:1821140658
Name:BRUCE, AMY LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 FLORA LAKE CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-8315
Mailing Address - Country:US
Mailing Address - Phone:618-972-1928
Mailing Address - Fax:618-628-9808
Practice Address - Street 1:1049 FLORA LAKE CT
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-8315
Practice Address - Country:US
Practice Address - Phone:618-972-1928
Practice Address - Fax:618-628-9808
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist