Healthcare Provider Details

I. General information

NPI: 1194803163
Provider Name (Legal Business Name): BRIDGID WHITFORD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 EUCLID AVE
CLEVELAND OH
44106-4319
US

IV. Provider business mailing address

11635 EUCLID AVE
CLEVELAND OH
44106-4319
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-8787
  • Fax: 216-231-7141
Mailing address:
  • Phone: 216-231-8787
  • Fax: 216-231-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.00915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: