Healthcare Provider Details

I. General information

NPI: 1164851622
Provider Name (Legal Business Name): BRIDGETT HANKERSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95687
US

IV. Provider business mailing address

PO BOX 2297
VACAVILLE CA
95696-8297
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: