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General NPI Number Information
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NPI Number | 1053226530
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Entity Type | Organization
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Legal Business Name | BRIGHT LIGHT THERAPY LLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 76 JACOBS AVENUE
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City | FAYETTEVILLE
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State | WV
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Zip | 25840
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Country | US
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Telephone | 304-663-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 63 S LEE ST
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-1158
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | EMILY SUNDSTROM
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Credential | M.S., CCC-SLP
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Telephone | 304-663-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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