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General NPI Number Information
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NPI Number | 1720992324
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Entity Type | Individual
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Provider Name | JACOB BRIGHT
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Gender | Male
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 203 S COLUMBIA AVE
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City | MORRIS
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State | MN
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Zip | 56267-1543
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Country | US
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Telephone | 320-589-4248
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Fax |
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Provider Business Mailing Address
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Address Line | 7421 COUNTY ROAD 1 SW
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City | KENSINGTON
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State | MN
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Zip | 56343-8145
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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 |
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Name |
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Credential |
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Telephone |
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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 | 1051543
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License Number State | MN
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