Provider Demographics
NPI:1497079263
Name:BRIGHT SPEECH-LANGUAGE PATHOLOGY, INC
Entity Type:Organization
Organization Name:BRIGHT SPEECH-LANGUAGE PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:M, S
Authorized Official - Phone:949-500-2847
Mailing Address - Street 1:30320 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1581
Mailing Address - Country:US
Mailing Address - Phone:949-500-2847
Mailing Address - Fax:949-661-1057
Practice Address - Street 1:30320 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1581
Practice Address - Country:US
Practice Address - Phone:949-500-2847
Practice Address - Fax:949-661-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty