MEDICARE: BRIGHTER BEGINNINGS THERAPY

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	:	1689562514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER BEGINNINGS THERAPY

Provider Business Mailing Address
First Line	:	379 METEOR LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-4938
Country	:	US
Telephone Number	:	702-501-1143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4285 SPONSON DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9271
Country	:	US
Telephone Number	:	928-255-7975
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	CASSIDY PHOENIX
Credential	:
Telephone Number	:	702-501-1143

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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