Healthcare Provider Details

I. General information

NPI: 1972413847
Provider Name (Legal Business Name): BRIDGEWAY INTEGRATED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 UNIVERSITY AVE STE 200
MADISON WI
53705-3611
US

IV. Provider business mailing address

8918 SNOWBERRY LN
VERONA WI
53593-7869
US

V. Phone/Fax

Practice location:
  • Phone: 414-208-1015
  • Fax:
Mailing address:
  • Phone: 414-208-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL DOYLE
Title or Position: FOUNDER/CEO
Credential: LPC
Phone: 414-208-1015