Provider Demographics
NPI:1508309113
Name:SEVEN BRIDGES SPEECH PATHOLOGY INC
Entity Type:Organization
Organization Name:SEVEN BRIDGES SPEECH PATHOLOGY INC
Other - Org Name:SEVEN BRIDGES THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP
Authorized Official - Phone:925-708-9050
Mailing Address - Street 1:100 LONGBROOK WAY # 2
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-7775
Mailing Address - Country:US
Mailing Address - Phone:510-250-9199
Mailing Address - Fax:888-429-1415
Practice Address - Street 1:300 LODGEPOLE CT
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3461
Practice Address - Country:US
Practice Address - Phone:510-250-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10617235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty