Provider Demographics
NPI:1801341094
Name:BRYANT, BERNICE RICHARDS (MED,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:RICHARDS
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4292
Mailing Address - Country:US
Mailing Address - Phone:727-467-9082
Mailing Address - Fax:
Practice Address - Street 1:1277 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4292
Practice Address - Country:US
Practice Address - Phone:727-467-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10877235Z00000X
CASP 21178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist