Individual
TED TERRY BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LICSW
Contact information
Practice address
6110 N PORT WASHINGTON RD, GLENDALE, WI 53217
(414) 332-7400
(414) 963-6866
Mailing address
6110 N PORT WASHINGTON RD, GLENDALE, WI 53217
(414) 332-3322
(414) 963-6866
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
3906-123
WI
Other
Enumeration date
12/28/2006
Last updated
07/08/2007
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