Provider Demographics
NPI:1801908959
Name:BRUHN, GERALD (LISW)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:BRUHN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 KENYON ROAD, SUITE C
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5718
Mailing Address - Country:US
Mailing Address - Phone:515-573-3138
Mailing Address - Fax:515-573-3130
Practice Address - Street 1:4301 SERGEANT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4726
Practice Address - Country:US
Practice Address - Phone:712-276-9000
Practice Address - Fax:712-276-4917
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA59291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical