Provider Demographics
NPI:1508356148
Name:TOBIN, BRIDGET (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5386 SELMARAINE DR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6052
Mailing Address - Country:US
Mailing Address - Phone:847-560-0030
Mailing Address - Fax:
Practice Address - Street 1:5386 SELMARAINE DR
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6052
Practice Address - Country:US
Practice Address - Phone:847-560-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist