Provider Demographics
NPI:1215158290
Name:BRUETT, AMANDA DENINE (MS)
Entity type:Individual
Prefix:MR
First Name:AMANDA
Middle Name:DENINE
Last Name:BRUETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 131
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323
Mailing Address - Country:US
Mailing Address - Phone:515-238-8799
Mailing Address - Fax:
Practice Address - Street 1:3606 131
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323
Practice Address - Country:US
Practice Address - Phone:515-238-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor