Provider Demographics
NPI:1356524706
Name:BRUNSON, SAUNDRA
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 LINCOLN MALL DR
Mailing Address - Street 2:SUITE #302
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3811
Mailing Address - Country:US
Mailing Address - Phone:708-679-0680
Mailing Address - Fax:708-679-0683
Practice Address - Street 1:4747 LINCOLN MALL DR
Practice Address - Street 2:SUITE #302
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3811
Practice Address - Country:US
Practice Address - Phone:708-679-0680
Practice Address - Fax:708-679-0683
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist