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General NPI Number Information
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NPI Number | 1376778894
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Entity Type | Individual
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Provider Name | BRIDGET B NOLAN
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Gender | Female
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 3503 GREENLEAF BLVD STE 201
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City | KALAMAZOO
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State | MI
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Zip | 49008-2580
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Country | US
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Telephone | 269-290-1390
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 LOVERS LN STE B
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City | PORTAGE
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State | MI
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Zip | 49002-1688
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013814
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401010951
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License Number State | MI
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