Provider Demographics
NPI:1134552540
Name:LANIGAN, BRIDGET ANNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANNE
Last Name:LANIGAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ANNE
Other - Last Name:LOBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:322 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5917
Mailing Address - Country:US
Mailing Address - Phone:636-449-1668
Mailing Address - Fax:636-527-9543
Practice Address - Street 1:322 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63021-5917
Practice Address - Country:US
Practice Address - Phone:636-449-1668
Practice Address - Fax:636-527-9543
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist