Provider Demographics
NPI:1457569493
Name:BRUCE, KATHRYN THERESE (NATIONALLY CERTIFIED)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:THERESE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NATIONALLY CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24139 QUAD PARK LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3022
Mailing Address - Country:US
Mailing Address - Phone:586-792-7416
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD STE D
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4714
Practice Address - Country:US
Practice Address - Phone:586-685-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist