Provider Demographics
NPI:1679280390
Name:BRUCE, CORTNEY (BCBA)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 HORSESHOE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2807
Mailing Address - Country:US
Mailing Address - Phone:734-846-8091
Mailing Address - Fax:
Practice Address - Street 1:180 JACKSON PLZ
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1959
Practice Address - Country:US
Practice Address - Phone:734-769-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst