Provider Demographics
NPI:1205018751
Name:SHAMBURG, BRIGID C (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BRIGID
Middle Name:C
Last Name:SHAMBURG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1413
Mailing Address - Country:US
Mailing Address - Phone:901-340-4418
Mailing Address - Fax:
Practice Address - Street 1:7907 OSTROW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3635
Practice Address - Country:US
Practice Address - Phone:858-565-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist