Healthcare Provider Details

I. General information

NPI: 1871300392
Provider Name (Legal Business Name): BRIDGETTE MARY ELLEN MCCARTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 N WHITMAN LN STE 140
LIBERTY LAKE WA
99019-6034
US

IV. Provider business mailing address

15821 E 4TH AVE APT F222
SPOKANE VALLEY WA
99037-7965
US

V. Phone/Fax

Practice location:
  • Phone: 509-443-5015
  • Fax:
Mailing address:
  • Phone: 360-335-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: