Provider Demographics
NPI:1437497732
Name:BRUSA, KATHLEEN C (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:C
Last Name:BRUSA
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:K
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:3803B COMPUTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6525
Mailing Address - Country:US
Mailing Address - Phone:919-791-3582
Mailing Address - Fax:919-791-3583
Practice Address - Street 1:3803B COMPUTER DR
Practice Address - Street 2:STE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-791-3582
Practice Address - Fax:919-791-3583
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist