1881100105 NPI number — BRIDGETTE MADELINE WALKER M.A., BCBA

Table of content: BRIDGETTE MADELINE WALKER M.A., BCBA (NPI 1881100105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881100105 NPI number — BRIDGETTE MADELINE WALKER M.A., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
BRIDGETTE
Provider Middle Name:
MADELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLINA
Provider Other First Name:
BRIDGETTE
Provider Other Middle Name:
MADELINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881100105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 767938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-7938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-241-6780
Provider Business Mailing Address Fax Number:
818-241-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12432 BELLFLOWER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6780
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
12/22/2017

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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