Healthcare Provider Details

I. General information

NPI: 1851049944
Provider Name (Legal Business Name): ALYSE CHRISTINE BRIGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

4935 W 112TH ST
INGLEWOOD CA
90304-2530
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7111
  • Fax:
Mailing address:
  • Phone: 310-344-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: