Healthcare Provider Details

I. General information

NPI: 1477016913
Provider Name (Legal Business Name): BRIDGET JONES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 BARTH LN
DAYTON OH
45429-1305
US

IV. Provider business mailing address

802 BARTH LN
DAYTON OH
45429-1305
US

V. Phone/Fax

Practice location:
  • Phone: 937-468-6868
  • Fax:
Mailing address:
  • Phone: 937-468-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08141
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: