Individual
MRS. MANDIE LYNN BRUYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC, APSW
Contact information
Practice address
10012 W CAPITOL DR, MILWAUKEE, WI 53222-1338
(414) 810-4844
Mailing address
19407 ROCK POINTE WAY UNIT 201, LANNON, WI 53046-2700
(715) 773-2916
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16622-131
WI
104100000X
Social Worker
Primary
132882-121
WI
Other
Enumeration date
12/28/2021
Last updated
10/03/2023
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