Provider Demographics
NPI:1265878201
Name:BRUGGINK, SANDRA KAYE (LPC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAYE
Last Name:BRUGGINK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:PHMG BEHAVIORAL MEDICINE CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-4036
Mailing Address - Fax:
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:PHMG BEHAVIORAL MEDICINE CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4970-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor