Healthcare Provider Details

I. General information

NPI: 1770974024
Provider Name (Legal Business Name): CHELSEY KAY BRIDGEMAN M.ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY KAY NORTHEY

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date: 08/28/2024
Reactivation Date: 09/04/2024

III. Provider practice location address

1800 NW 167TH PL STE 115
BEAVERTON OR
97006-4846
US

IV. Provider business mailing address

6415 CENTRAL AVE
CLINTON WA
98236-9698
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 360-434-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number477
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA60932686
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH007703
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33235
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: