Provider Demographics
NPI:1225537715
Name:BEACH CITIES SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:BEACH CITIES SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HILLSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:508-561-5191
Mailing Address - Street 1:2517 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2731
Mailing Address - Country:US
Mailing Address - Phone:310-684-3896
Mailing Address - Fax:
Practice Address - Street 1:2517 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2731
Practice Address - Country:US
Practice Address - Phone:310-684-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18793235Z00000X
CA18173235Z00000X
CA10982235Z00000X
CA13378235Z00000X
CA21866235Z00000X
CA23301235Z00000X
CA15866235Z00000X
CA19248235Z00000X
CA24536235Z00000X
CA13260235Z00000X
CA22933235Z00000X
CA23239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty