Provider Demographics
NPI:1992138143
Name:LEVIT, BRIDGET LEIGH (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:LEIGH
Last Name:LEVIT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CLARK LN # A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4101
Mailing Address - Country:US
Mailing Address - Phone:508-561-5191
Mailing Address - Fax:
Practice Address - Street 1:1701 CLARK LN # A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4101
Practice Address - Country:US
Practice Address - Phone:508-561-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist