Provider Demographics
NPI:1619455763
Name:PEREZ, BRIDGET LOLLIS
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:LOLLIS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRIDGET
Other - Middle Name:CONNALLY
Other - Last Name:LOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7112 N WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4875
Mailing Address - Country:US
Mailing Address - Phone:509-944-6302
Mailing Address - Fax:
Practice Address - Street 1:7112 N WINSTON DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4875
Practice Address - Country:US
Practice Address - Phone:509-944-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61185153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61185153OtherWA STATE DOH