MEDICARE: BRIDGET BAKER DICKSON LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	681	LA

General Provider Information

NPI Number	:	1053657742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET BAKER DICKSON LAC

Provider Business Mailing Address
First Line	:	1295 FLORIDA AVE SW
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4635
Country	:	US
Telephone Number	:	225-281-8115
Fax Number	:	225-243-6029

Provider Business Practice Location Address
First Line	:	1295 FLORIDA AVE SW
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4635
Country	:	US
Telephone Number	:	225-281-8115
Fax Number	:	225-243-6029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	12/27/2012

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Directions to “ BRIDGET BAKER DICKSON LAC” Practice Location

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