Provider Demographics
NPI:1356108872
Name:BRUSCATO, JACQUELYN (AAS-HIS)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BRUSCATO
Suffix:
Gender:F
Credentials:AAS-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 N DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3086
Mailing Address - Country:US
Mailing Address - Phone:816-808-5598
Mailing Address - Fax:
Practice Address - Street 1:8130 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1101
Practice Address - Country:US
Practice Address - Phone:816-439-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005794237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist