Provider Demographics
NPI:1851069934
Name:BRUCK, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 JACKSON OAKS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-0708
Mailing Address - Country:US
Mailing Address - Phone:719-649-0009
Mailing Address - Fax:
Practice Address - Street 1:10420 JACKSON OAKS WAY STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0708
Practice Address - Country:US
Practice Address - Phone:719-649-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health