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General NPI Number Information
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NPI Number | 1457688194
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Entity Type | Organization
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Legal Business Name | BRIGHT START SPEECH AND LANGUAGE SERVICES, LTD.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 141 BRISTLEWOOD CT
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City | ROCKTON
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State | IL
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Zip | 61072-3217
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Country | US
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Telephone | 815-997-4501
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Fax | 815-624-8087
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Provider Business Mailing Address
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Address Line | 141 BRISTLEWOOD CT
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City | ROCKTON
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State | IL
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Zip | 61072-3217
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Country | US
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Telephone | 815-997-4501
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Fax | 815-624-8087
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KRISTEN MARIE MILLER
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Credential | M.A., CCC-SLP/L
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Telephone | 815-997-4501
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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 | 146006310
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License Number State | IL
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