MEDICARE: BUILDING BRIDGES THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1144940438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BRIDGES THERAPY LLC

Provider Business Mailing Address
First Line	:	5121 CHAMBLISS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2171
Country	:	US
Telephone Number	:	702-528-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 CHAMBLISS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2171
Country	:	US
Telephone Number	:	702-528-0981
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VICKI CLEVERLEY WARDELL
Credential	:	MA CCC-SLP
Telephone Number	:	702-528-0981

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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