Provider Demographics
NPI:1831390335
Name:BRUTON, WENDY S (MA, QMHP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:S
Last Name:BRUTON
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 EAGLE CREST RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-9729
Mailing Address - Country:US
Mailing Address - Phone:503-390-2622
Mailing Address - Fax:
Practice Address - Street 1:131 PINE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0728
Practice Address - Country:US
Practice Address - Phone:503-910-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health