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General NPI Number Information
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NPI Number | 1275953077
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY HOUSE
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 37770 UPPER CAMP CREEK RD
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City | SPRINGFIELD
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State | OR
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Zip | 97478-8753
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Country | US
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Telephone | 541-345-0805
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Fax | 541-345-0855
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Provider Business Mailing Address
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Address Line | 37770 UPPER CAMP CREEK RD
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City | SPRINGFIELD
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State | OR
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Zip | 97478-8753
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Country | US
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Telephone | 541-345-0805
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Fax | 541-345-0855
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA B. WIGNEY
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Credential |
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Telephone | 541-345-0805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12644
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License Number State | OR
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