Provider Demographics
NPI:1720530843
Name:MINNICK, BRIDGET LEANNE (SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:LEANNE
Last Name:MINNICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:LEANNE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3110
Mailing Address - Country:US
Mailing Address - Phone:256-381-1110
Mailing Address - Fax:256-314-5105
Practice Address - Street 1:1450 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3110
Practice Address - Country:US
Practice Address - Phone:256-381-1110
Practice Address - Fax:256-314-5105
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist