Provider Demographics
NPI:1861651689
Name:BRULZ, JINGER K (MSE CFY-SLP)
Entity Type:Individual
Prefix:
First Name:JINGER
Middle Name:K
Last Name:BRULZ
Suffix:
Gender:F
Credentials:MSE CFY-SLP
Other - Prefix:
Other - First Name:JINGER
Other - Middle Name:K
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:687 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1007
Mailing Address - Country:US
Mailing Address - Phone:715-220-0348
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist