Provider Demographics
NPI:1689177529
Name:HARDY, BRIDGET KEELIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:KEELIN
Last Name:HARDY
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 1:1320 ALMA AVE APT C201
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5042
Mailing Address - Country:US
Mailing Address - Phone:925-421-7082
Mailing Address - Fax:
Practice Address - Street 1:75100 MEDITERRANEAN
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9069
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA16010235Z00000X
CA33802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician