Healthcare Provider Details

I. General information

NPI: 1679835789
Provider Name (Legal Business Name): BRIDGETTE ASHLEY BECKER CMT, CD, BFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 W WALTON BLVD SUITE A
WATERFORD MI
48329-3566
US

IV. Provider business mailing address

4624 W WALTON BLVD SUITE A
WATERFORD MI
48329-3566
US

V. Phone/Fax

Practice location:
  • Phone: 248-882-2015
  • Fax:
Mailing address:
  • Phone: 248-882-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: