MEDICARE: BRIGHTSIDE SPEECH THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1225872336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSIDE SPEECH THERAPY

Provider Business Mailing Address
First Line	:	3283 MARLENE DR
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4723
Country	:	US
Telephone Number	:	630-656-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	3283 MARLENE DR
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4723
Country	:	US
Telephone Number	:	630-656-4224
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FOUNDER; SLP
Name	:	JULIE BRINKMAN
Credential	:	M.S. CCC-SLP
Telephone Number	:	630-656-4224

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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Directions to “BRIGHTSIDE SPEECH THERAPY ” Practice Location

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