Individual
ERIC J. BRUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
S74W16775 JANESVILLE RD, MUSKEGO, WI 53150
(414) 773-4312
(414) 422-2188
Mailing address
S74W16775 JANESVILLE RD, MUSKEGO, WI 53150-7742
(414) 773-4312
(414) 422-2188
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
00716
IA
103T00000X
Psychologist
Primary
3597
WI
103TC0700X
Clinical Psychologist
00716
IA
103TH0100X
Health Service Psychologist
00280
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100083826
—
WI
05
—
420716337
—
IA
Enumeration date
02/08/2007
Last updated
08/26/2020
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