Provider Demographics
NPI:1205070521
Name:BRIGHT, STACEY A
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:AMBER
Other - Last Name:THOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30320 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1581
Mailing Address - Country:US
Mailing Address - Phone:949-500-2847
Mailing Address - Fax:949-661-1057
Practice Address - Street 1:30320 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1581
Practice Address - Country:US
Practice Address - Phone:949-500-2847
Practice Address - Fax:949-661-1057
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist