Provider Demographics
NPI:1942423322
Name:BRUNE, MARY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRUNE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7992 BEEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GERALD
Mailing Address - State:MO
Mailing Address - Zip Code:63037-1102
Mailing Address - Country:US
Mailing Address - Phone:573-764-3321
Mailing Address - Fax:
Practice Address - Street 1:402 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1445
Practice Address - Country:US
Practice Address - Phone:573-437-2177
Practice Address - Fax:573-437-5808
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12094844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist