Provider Demographics
NPI:1154667343
Name:MOONEY, BRIDGET (CCC SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC SLP
Mailing Address - Street 1:4730 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2927
Mailing Address - Country:US
Mailing Address - Phone:425-385-5250
Mailing Address - Fax:
Practice Address - Street 1:4730 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2927
Practice Address - Country:US
Practice Address - Phone:425-385-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01109282OtherCCC SLP
WALL000003937OtherSTATE LICENSE