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General NPI Number Information
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NPI Number | 1033254677
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Entity Type | Organization
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Legal Business Name | J. ALLEN BRIDGMAN PEDIATRIC SPEECH PATHOLOGY, PLLC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 212 CLAREMONT AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2731
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Country | US
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Telephone | 502-314-5884
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Fax | 502-897-9893
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Provider Business Mailing Address
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Address Line | 212 CLAREMONT AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2731
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Country | US
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Telephone | 502-314-5884
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Fax | 502-897-9893
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEAN ALLEN BRIDGMAN
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Credential | M.S.CCC-SLP
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Telephone | 502-314-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2246
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License Number State | KY
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