Provider Demographics
NPI:1972836278
Name:BRUCKNER, STEPHANY LYNN (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANY
Middle Name:LYNN
Last Name:BRUCKNER
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:LYNN
Other - Last Name:BRUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:402 W NESHANNOCK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1011
Mailing Address - Country:US
Mailing Address - Phone:412-849-4953
Mailing Address - Fax:
Practice Address - Street 1:402 W NESHANNOCK AVE
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1011
Practice Address - Country:US
Practice Address - Phone:412-849-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist