Provider Demographics
NPI:1609019330
Name:BRUINIUS, JESSICA JONES (MS)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JONES
Last Name:BRUINIUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 DRIFTWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7890
Mailing Address - Country:US
Mailing Address - Phone:616-682-2789
Mailing Address - Fax:
Practice Address - Street 1:1179 EAST PARIS AVE SE #100
Practice Address - Street 2:COMPREHENSIVE EAR, NOSE AND THROAT, P.C.
Practice Address - City:GRAND RAPIDS TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-942-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI231H00000X, 231HA2400X, 231HA2500X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter