Provider Demographics
NPI:1306285044
Name:RUDE, CAROL BRUNO
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:BRUNO
Last Name:RUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JANE
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:121 TRAYMORE LN
Mailing Address - Street 2:
Mailing Address - City:ROSE VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5958
Mailing Address - Country:US
Mailing Address - Phone:484-343-6919
Mailing Address - Fax:
Practice Address - Street 1:121 TRAYMORE LN
Practice Address - Street 2:
Practice Address - City:ROSE VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19063-5958
Practice Address - Country:US
Practice Address - Phone:484-343-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005903L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist