Individual
JUDY BRUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1551 JENNINGS MILL RD UNIT 2000B, WATKINSVILLE, GA 30677-7252
(706) 316-9095
(706) 353-8948
Mailing address
1551 JENNINGS MILL RD UNIT 2000B, WATKINSVILLE, GA 30677-7252
(706) 316-9095
(706) 353-8948
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2174
GA
103TC1900X
Counseling Psychologist
2174
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
582430452
BLUE CROSS BLUE SHIELD GA
GA
Enumeration date
09/20/2006
Last updated
01/17/2023
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