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NPI Code Detail

MEDICARE: DR. PATRICIA E BRIDGEWATER PSY.D.

MEDICARE: DR. PATRICIA E BRIDGEWATER PSY.D.
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
1103TC0700XClinical Psychologist1999140492MO
2103TC0700XClinical Psychologist6301011168MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356426308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICIA E BRIDGEWATER PSY.D.
Provider Business Mailing Address
First Line : 1819 W AUSTIN BLVD STE C
Second Line : PO BOX 177
City : NEVADA
State : MO
Zip : 64772-3708
Country : US
Telephone Number : 417-283-6151
Fax Number : 417-283-6152
Provider Business Practice Location Address
First Line : 1819 WEST AUSTIN, SUITE C
Second Line :
City : NEVADA
State : MO
Zip : 64772-2202
Country : US
Telephone Number : 417-283-6151
Fax Number : 417-283-6152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 02/24/2014

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