Provider Demographics
NPI:1811180573
Name:BRUNICK, BRAD MICHAEL (PSYD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:MICHAEL
Last Name:BRUNICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3928
Mailing Address - Country:US
Mailing Address - Phone:319-354-3232
Mailing Address - Fax:319-354-2990
Practice Address - Street 1:209 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3928
Practice Address - Country:US
Practice Address - Phone:319-354-3232
Practice Address - Fax:319-354-2990
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000496OtherHSP