Provider Demographics
NPI:1710262662
Name:BUILDING BRIDGES THERAPY CLINIC, LLC
Entity Type:Organization
Organization Name:BUILDING BRIDGES THERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:956-460-9697
Mailing Address - Street 1:900 E 13 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3194
Mailing Address - Country:US
Mailing Address - Phone:956-460-9697
Mailing Address - Fax:
Practice Address - Street 1:900 E 13 1/2 ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3194
Practice Address - Country:US
Practice Address - Phone:956-283-5499
Practice Address - Fax:855-298-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209896401Medicaid