Provider Demographics
NPI:1245890623
Name:BRUCH, TORI RAE (MSW, APSW)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:RAE
Last Name:BRUCH
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9618 WATTS RD APT 204
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9674
Mailing Address - Country:US
Mailing Address - Phone:608-963-7479
Mailing Address - Fax:
Practice Address - Street 1:2155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-9440
Practice Address - Country:US
Practice Address - Phone:608-415-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131525-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker