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General NPI Number Information
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NPI Number | 1497079263
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Entity Type | Organization
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Legal Business Name | BRIGHT SPEECH-LANGUAGE PATHOLOGY, INC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 30320 RANCHO VIEJO RD SUITE 2
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1581
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Country | US
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Telephone | 949-500-2847
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Fax | 949-661-1057
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Provider Business Mailing Address
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Address Line | 30320 RANCHO VIEJO RD SUITE 2
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1581
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Country | US
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Telephone | 949-500-2847
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Fax | 949-661-1057
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. STACEY AMBER BRIGHT
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Credential | M, S.
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Telephone | 949-500-2847
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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 | SP13502
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License Number State | CA
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