Individual
DR. NICCOLE K BRUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
121 FAIRFIELD WAY, SUITE 240, BLOOMINGDALE, IL 60108-1588
(630) 309-2989
Mailing address
121 FAIRFIELD WAY, SUITE 240, BLOOMINGDALE, IL 60108-1588
(630) 309-2989
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071009162
IL
Other
Enumeration date
02/04/2016
Last updated
02/04/2016
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