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General NPI Number Information
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NPI Number | 1265919039
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Entity Type | Organization
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Legal Business Name | BRIDGEPOINT PSYCHOLOGY CENTER INC.
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 12
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 773-349-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 N RAVENSWOOD AVE APT 107
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City | CHICAGO
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State | IL
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Zip | 60640-4478
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/FOUNDER
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Name | DR. BRITTANY ELISE TRAUTHWEIN
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Credential | PSYD
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Telephone | 941-447-5870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009518
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License Number State | IL
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