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NPI Code Detail

MEDICARE: MS. BARBARA JEANNE BRIDGES LCSW

MEDICARE: MS. BARBARA JEANNE BRIDGES LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1912024779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BARBARA JEANNE BRIDGES LCSW
Provider Business Mailing Address
First Line : 14528 N US HIGHWAY 51
Second Line :
City : DE SOTO
State : IL
Zip : 62924-3210
Country : US
Telephone Number : 618-924-1845
Fax Number :
Provider Business Practice Location Address
First Line : 1307 W MAIN ST
Second Line :
City : MARION
State : IL
Zip : 62959-1139
Country : US
Telephone Number : 618-997-5336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2007
Last Update Date : 07/08/2007

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