Healthcare Provider Details

I. General information

NPI: 1366618316
Provider Name (Legal Business Name): BRIDGET GARRISON A.U.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 DUNN RD
FLORISSANT MO
63031-7928
US

IV. Provider business mailing address

253 DUNN RD
FLORISSANT MO
63031-7928
US

V. Phone/Fax

Practice location:
  • Phone: 314-921-7770
  • Fax: 314-921-1417
Mailing address:
  • Phone: 314-921-7770
  • Fax: 314-921-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number02110
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: