1689710311 NPI number — MS. BEVERLY G. BRIDGE M.S. IN CLINCIAL PSY

Table of content: MS. BEVERLY G. BRIDGE M.S. IN CLINCIAL PSY (NPI 1689710311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689710311 NPI number — MS. BEVERLY G. BRIDGE M.S. IN CLINCIAL PSY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGE
Provider First Name:
BEVERLY
Provider Middle Name:
G.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. IN CLINCIAL PSY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689710311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 SE 34TH PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-232-1652
Provider Business Mailing Address Fax Number:
425-635-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LAKE BELLEVUE DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-441-3556
Provider Business Practice Location Address Fax Number:
425-635-0883
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF00000877 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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