Provider Demographics
NPI:1518202399
Name:BRIDGE COMMUNICATION SPEECH/LANGUAGE PATHOLOGISTS
Entity Type:Organization
Organization Name:BRIDGE COMMUNICATION SPEECH/LANGUAGE PATHOLOGISTS
Other - Org Name:BRIDGE COMMUNICATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:805-822-9968
Mailing Address - Street 1:1546 WINDSHORE WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1401
Mailing Address - Country:US
Mailing Address - Phone:805-822-9968
Mailing Address - Fax:805-650-5919
Practice Address - Street 1:1546 WINDSHORE WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1401
Practice Address - Country:US
Practice Address - Phone:805-822-9968
Practice Address - Fax:805-650-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty