Healthcare Provider Details

I. General information

NPI: 1689177529
Provider Name (Legal Business Name): BRIDGET KEELIN HARDY MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 08/27/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75100 MEDITERRANEAN
PALM DESERT CA
92211-9069
US

IV. Provider business mailing address

1320 ALMA AVE APT C201
WALNUT CREEK CA
94596-5042
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-0033
  • Fax:
Mailing address:
  • Phone: 925-421-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16010
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: